Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Centre, The Netherlands.
Otol Neurotol. 2011 Feb;32(2):338-44. doi: 10.1097/MAO.0b013e3182040d9f.
The purpose of this study was to identify factors predicting growth and audiologic deterioration during follow-up (FU) in a wait and scan (W&S) policy of vestibular schwannomas (VSs) using a novel volumetric measuring tool. So far, only consecutive magnetic resonance imaging (MRI) is able to show growth objectively, and growth, combined with hearing function, generally dictates further intervention. Other factors predicting growth or hearing deterioration would be invaluable and might ease clinical decision making.
Retrospective case study.
Tertiary referral center.
Sixty-three patients diagnosed with VS at Maastricht University Medical Center between 2003 and 2008, with FU data available from 36 patients.
INTERVENTION(S): A W&S policy for unilateral VS with sequential contrast-enhanced T1- and T2-weighted MRI and audiograms during FU.
MAIN OUTCOME MEASURE(S): 1. Patient and radiologic VS features potentially related to growth and auditory function during a W&S policy. 2. The correlation between increase in VS volume and audiologic deterioration during FU.
Labyrinthine hypointensity on T2-weighted magnetic resonance images and complaints of hearing loss at presentation are predictive of a faster deterioration of hearing (p < 0.05). Growth during the first FU year predicts further growth. Vestibular schwannoma volume does not correlate with audiologic deterioration significantly.
Hypointensity on T2-weighted image of the affected labyrinth will result in a significant faster deterioration of hearing. Hearing loss was more profound, and hearing will deteriorate significantly faster in patients presenting with complaints of hearing loss. Significant growth during the first year of FU predicts further growth during FU. Sequential MRI cannot be substituted by audiologic examinations solely because increase in VS volume does not correlate with audiologic deterioration significantly.
本研究旨在使用一种新的容积测量工具，确定在桥小脑角肿瘤（VSs）的等待和扫描（W&S）策略中，预测随访（FU）期间生长和听力恶化的因素。到目前为止，只有连续的磁共振成像（MRI）才能客观地显示生长，而生长结合听力功能通常决定了进一步的干预。其他预测生长或听力恶化的因素将是非常宝贵的，可能会简化临床决策。
回顾性病例研究。
三级转诊中心。
2003 年至 2008 年在马斯特里赫特大学医学中心诊断为 VS 的 63 例患者，其中 36 例患者有 FU 数据。
单侧 VS 采用 W&S 策略，在 FU 期间进行连续对比增强 T1 和 T2 加权 MRI 和听力图。
T2 加权磁共振图像上的迷路低信号和就诊时听力损失的主诉与听力更快恶化相关（p < 0.05）。第一年 FU 期间的生长预测进一步生长。VS 体积与听力恶化无显著相关性。
受影响迷路的 T2 加权图像上的低信号将导致听力显著更快恶化。听力损失更严重，就诊时主诉听力损失的患者听力将显著更快恶化。FU 第一年的显著生长预测 FU 期间的进一步生长。连续 MRI 不能仅通过听力检查替代，因为 VS 体积的增加与听力恶化无显著相关性。
