Rahmathulla Gazanfar, Barnett Gene H
Department of Neurosurgery, The Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, The Cleveland Clinic, Cleveland, Ohio, USA.
Surg Neurol Int. 2011;2:187. doi: 10.4103/2152-7806.91142. Epub 2011 Dec 26.
Vestibular schwannomas are benign brain tumors arising from the 8th cranial nerve with a varying natural history. Various reports have described discernable growth patterns for these tumors. However, growth predictability remains low because of slow and indeterminate changes over time with follow-up reports not usually exceeding 3 years. Our report describes the long-term follow-up of an unusual cystic schwannoma with growth patterns prior to and following treatment, adding valuable information to the variable natural history and outcome of these infrequent tumors.
A 68-year-old gentleman presented with a left-sided cystic vestibular schwannoma, initially managed conservatively. Imaging revealed wide variations in the size of his tumor over a period of 3 years. He was finally treated with Gamma Knife radiosurgery, and at 1 year following treatment shows tumor shrinkage with a change in tumor morphology.
To our knowledge, the present case represents the first instance of a schwannoma showing wide fluctuations in tumor size and morphology over a period of time, with a good response to radiosurgery. We emphasize in this report that there is no "one size fits all" treatment paradigm for these tumors and each patient requires individualized care and intervention, taking into account their differing natural histories.
前庭神经鞘瘤是起源于第8对脑神经的良性脑肿瘤，其自然病程各异。各种报告描述了这些肿瘤可识别的生长模式。然而，由于随着时间推移变化缓慢且不确定，且随访报告通常不超过3年，生长可预测性仍然较低。我们的报告描述了一例罕见的囊性神经鞘瘤的长期随访情况，包括治疗前后的生长模式，为这些罕见肿瘤多变的自然病程和转归增添了有价值的信息。
一名68岁男性患有左侧囊性前庭神经鞘瘤，最初采用保守治疗。影像学检查显示其肿瘤大小在3年内有很大变化。他最终接受了伽玛刀放射外科治疗，治疗后1年肿瘤缩小，形态改变。
据我们所知，本病例是首例神经鞘瘤在一段时间内肿瘤大小和形态出现大幅波动且对放射外科治疗反应良好的情况。我们在本报告中强调，对于这些肿瘤不存在“一刀切”的治疗模式，每个患者都需要个体化的护理和干预，要考虑到他们不同的自然病程。
