Departments of Otolaryngology, Head and Neck Surgery, Maastricht University, Maastricht, The Netherlands.
J Neurosurg. 2011 Nov;115(5):875-84. doi: 10.3171/2011.6.JNS101958. Epub 2011 Aug 12.
In large vestibular schwannoma (VS), microsurgery is the main treatment option, and complete resection is considered the primary goal. However, previous studies have documented suboptimal facial nerve outcomes in patients who undergo complete resection of large VSs. Subtotal resection is likely to reduce the risk of facial nerve injury but increases the risk of lesion regrowth. Gamma Knife surgery (GKS) can be performed to achieve long-term growth control of residual VS after incomplete resection. In this study the authors report on the results in patients treated using planned subtotal resection followed by GKS with special attention to volumetric growth, control rate, and symptoms.
Fifty consecutive patients who underwent the combined treatment strategy of subtotal microsurgical removal and GKS for large VSs between 2002 and 2009 were retrospectively analyzed. Patients with neurofibromatosis Type 2 were excluded. Patient charts were reviewed for clinical symptoms. Audiograms were evaluated to classify hearing pre- and postoperatively. Preoperative and follow-up contrast-enhanced T1-weighted MR images were analyzed using volume-measuring software.
Surgery was performed via a translabyrinthine (25 patients) or retrosigmoid (25 patients) approach. The median follow-up was 33.8 months. Clinical control was achieved in 92% of the cases and radiological control in 90%. One year after radiosurgery, facial nerve function was good (House-Brackmann Grade I or II) in 94% of the patients. One of the two patients who underwent surgery to preserve hearing maintained serviceable hearing after resection followed by GKS.
Considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by GKS can be the treatment option of choice for large VSs.
在大型前庭神经鞘瘤（VS）中，显微手术是主要的治疗选择，完全切除被认为是主要目标。然而，之前的研究记录了在接受大型 VS 完全切除的患者中面神经结果不理想。次全切除可能降低面神经损伤的风险，但增加病变复发的风险。伽玛刀手术（GKS）可用于控制不完全切除后残余 VS 的长期生长。在这项研究中，作者报告了采用计划的次全切除后行 GKS 治疗的患者结果，特别关注体积生长、控制率和症状。
回顾性分析了 2002 年至 2009 年间采用次全显微切除联合 GKS 治疗大型 VS 的 50 例连续患者。排除神经纤维瘤病 2 型患者。评估患者病历以了解临床症状。评估听力图以对术前和术后听力进行分类。使用体积测量软件对术前和随访的增强 T1 加权磁共振图像进行分析。
手术通过经迷路（25 例）或乙状窦后（25 例）入路进行。中位随访时间为 33.8 个月。92%的病例临床控制良好，90%的病例影像学控制良好。放射治疗后 1 年，94%的患者面神经功能良好（House-Brackmann 分级 I 或 II）。在接受手术保留听力的两名患者中，有 1 名患者在切除后行 GKS 治疗，保留了有用听力。
考虑到良好的肿瘤生长控制和保留面神经功能，以及保留有用听力的可能性以及并发症数量较少，次全切除联合 GKS 可以作为大型 VS 的治疗选择。
