Eljamel Sarah, Hussain Musheer, Eljamel M Sam
Skull Base. 2011 Jan;21(1):59-64. doi: 10.1055/s-0030-1265824.
Early diagnosis of vestibular schwannoma (VS) has increased in recent years because of increased longevity and availability of magnetic resonance imaging (MRI). Initial conservative radiological surveillance is often requested by patients and physicians to establish whether these tumors are growing before embarking on intervention. Initial observation of at least 1 year in all small VS was therefore recommended by some authors. We evaluated our prospective skull base database of VSs that were managed with initial radiological surveillance to establish when this policy should be abandoned and what predicts future growth. Fifty-four consecutive patients with VS in our institution who were managed by initial yearly MRI scanning were studied. The MRI data were collected prospectively and analyzed by Kodak CareStream viewing software where VS maximum diameters in three perpendicular planes and volume were calculated. One patient was excluded from the analysis as he had only one MRI follow-up. The median age of the 53 patients was 59 years (range, 26 to 86 years), 25 were males and 28 were females, and 33 were under 65 years of age; 18 VSs were extracanalicular, 18 were intracanalicular, and 17 extended both inside and outside the canal; 21 VSs were 1.2 cm(3) or less, 22 were 1.2 to 4 cm(3), and the rest were >4 cm(3). Using volumetric analysis, 29.72% of conservatively managed VS grew by at least 2 mm per year, and 70.82% did not grow in 5 years. Age, gender, symptoms, and side did not predict future growth. However, growth in the first year was a strong predictor of future growth (p < 0.001) and initial volume was also a strong predictor of future growth (p < 0.05). Twenty-nine percent of observed VSs grew by at least 2 mm per year in the first 5 years of surveillance. As the growth rate is slow, initial radiological surveillance is justified in elderly patients and patients with small VSs and nonserviceable hearing. Growth in the first year was a strong predictor of future growth. The reported treatment effect should be interpreted in the light of 70.24% of VSs that either shrink or do not change in the first 5 years.
近年来，由于寿命延长以及磁共振成像（MRI）的普及，前庭神经鞘瘤（VS）的早期诊断有所增加。患者和医生通常要求进行初步的保守放射学监测，以确定这些肿瘤在开始干预之前是否在生长。因此，一些作者建议对所有小型VS至少进行1年的初始观察。我们评估了我们的VS前瞻性颅底数据库，这些VS通过初始放射学监测进行管理，以确定何时应放弃该策略以及预测未来生长的因素。研究了我们机构中连续54例通过每年进行一次MRI扫描进行管理的VS患者。MRI数据是前瞻性收集的，并通过柯达CareStream查看软件进行分析，计算VS在三个垂直平面上的最大直径和体积。一名患者因仅进行了一次MRI随访而被排除在分析之外。53例患者的中位年龄为59岁（范围26至86岁），男性25例，女性28例，33例年龄在65岁以下；18例VS为管外型，18例为管内型，17例延伸至管内外；21例VS体积为1.2 cm³或更小，22例为1.2至4 cm³，其余大于4 cm³。使用体积分析，29.72%接受保守治疗的VS每年至少生长2 mm，70.82%在5年内未生长。年龄、性别、症状和患侧并不能预测未来生长。然而，第一年的生长是未来生长的有力预测指标（p < 0.001），初始体积也是未来生长的有力预测指标（p < 0.05）。在监测的前5年中，29%观察到的VS每年至少生长2 mm。由于生长速度缓慢，对于老年患者、小型VS患者和听力丧失的患者，初始放射学监测是合理的。第一年的生长是未来生长的有力预测指标。鉴于70.24%的VS在最初5年内缩小或无变化，所报道的治疗效果应据此进行解读。
