Régis J, Carron R, Moucharrafien S, Delsantin C, Porcheron D, Thomassin J-M, Murracciole X, Roche P-H
Service de neurochirurgie fonctionnelle et stéréotaxique, hôpital universitaire La Timone, 264 boulevard St-Pierre, Marseille, France.
Cancer Radiother. 2012 Jun;16 Suppl:S70-8. doi: 10.1016/j.canrad.2012.01.006. Epub 2012 Jun 8.
In order to investigate the role of radiosurgery and stereotactic radiotherapy in the management of vestibular schwannomas, we have reviewed our own prospective cohort and the main series of the modern literature.
Between July 14th 1992 and June 1st 2011, 2991 vestibular schwannomas were operated on the Stereotactic and Functional Neurosurgery Department of Timone University Hospital. All the patients have been evaluated prospectively, with a follow up longer than 3 years for 2336 patients, excluding patients suffering from type 2 neurofibromatosis (148 patients). In 7% of the patients, the vestibular schwannoma had previously been resected. According to Koos classification, in 17.6% of the patients, vestibular schwannomas were stage I, 51.8% stage II, 27% stage III and 3.6% stage IV. The mean tumour volume was 2.63 cm(3). According to Garner Robertson classification, the hearing was still functional at the time of radiosurgery in 46% and subnormal in 20.9% of the patients.
Long term tumour control was achieved in 97.5% of the patients. A transient facial palsy was observed in 0.5% of the cases. The rate of trigeminal injury was 0.5%. Useful hearing was preserved at 3 years in 78%. This rate reached 95% in patients with no past history of sudden hearing loss. Other predictors of functional hearing preservation are the young age, the small size of the lesion and a dose to the modiulus of the cochlea lower than 4Gy. We observed no radio-induced tumour. Only large, Koos IV vestibular schwannomas are contraindicated for upfront radiosurgery. In these patients, we propose a combined approach with a deliberately partial microsurgical removal, followed by a radiosurgery of the residue.
This cohort is unique by the size of the population and the length of the follow up and results demonstrate the efficacy of radiosurgery and its safety, especially its high rate of hearing preservation.
为了探讨放射外科和立体定向放射治疗在前庭神经鞘瘤治疗中的作用，我们回顾了我们自己的前瞻性队列以及现代文献中的主要系列研究。
1992年7月14日至2011年6月1日期间，2991例前庭神经鞘瘤在蒂蒙大学医院立体定向与功能神经外科接受手术。所有患者均接受前瞻性评估，2336例患者随访时间超过3年，排除患有2型神经纤维瘤病的患者（148例）。7%的患者前庭神经鞘瘤此前已被切除。根据库斯分类，17.6%的患者前庭神经鞘瘤为I期，51.8%为II期，27%为III期，3.6%为IV期。肿瘤平均体积为2.63立方厘米。根据加纳·罗伯逊分类，放射外科治疗时46%的患者听力仍正常，20.9%的患者听力低于正常水平。
97.5%的患者实现了长期肿瘤控制。0.5%的病例观察到短暂性面瘫。三叉神经损伤率为0.5%。78%的患者在3年后保留了有用听力。在无突发性听力损失既往史的患者中，这一比例达到95%。功能听力保留的其他预测因素包括年轻、病变体积小以及耳蜗蜗轴剂量低于4Gy。我们未观察到放射诱发的肿瘤。只有大型的库斯IV期前庭神经鞘瘤不适合直接进行放射外科治疗。对于这些患者，我们建议采用联合方法，先进行有意的部分显微手术切除，然后对残余部分进行放射外科治疗。
该队列在人群规模和随访时间方面具有独特性，结果证明了放射外科的有效性及其安全性，尤其是其高听力保留率。
