Fayad Jose N, Semaan Maroun T, Lin James, Berliner Karen I, Brackmann Derald E
*House Research Institute and House Clinic, Los Angeles, California; †Ear, Nose and Throat Institute, Case Western Reserve School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio; ‡Department of Otolaryngology and Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas; and §Clinical Research Consultant to House Research Institute, Marina del Rey, California, U.S.A.
Otol Neurotol. 2014 Aug;35(7):1258-65. doi: 10.1097/MAO.0000000000000285.
Evaluate long-term prevalence of tumor growth and need for further treatment in patients with a vestibular schwannoma treated with conservative management.
Retrospective chart review.
Private neurotologic tertiary referral center.
Vestibular schwannoma patients undergoing conservative management and previously studied (N = 114). Mean time to last magnetic resonance imaging was 4.8 years and to last follow-up was 6.4 years (maximum, 18.5 yr).
Serial gadolinium-enhanced magnetic resonance imaging with size measurement.
Change in maximum tumor dimension of 2 mm or higher (growth), further treatment, audiologic measures-pure-tone average, word recognition, AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) hearing class.
Thirty-eight percent of tumors demonstrated growth; an average of 6.5 mm (SD, 3.8) at a mean rate of 3.1 mm per year. Of patients with no growth at 1 year or less, 20% grew by last follow-up. Overall, 31% had further treatment after a mean of 3.8 years (SD, 3.5; maximum, 18.5 yr). Of those followed for 5 to 10 years, 18% eventually had further treatment. Only 56% of growing tumors had further treatment by last follow-up; 14.8% with nongrowing tumors also had further treatment. Pure-tone average declined more in tumors that grew (mean Δ = 28.8 dB) than those that did not (mean Δ = 16.5 dB) (p ≤ 0.025), but there was no correlation between the amount of change in hearing and in the size of the tumor. Of patients with an initial AAO-HNS hearing Class A, 85.7% retained serviceable hearing.
For patients electing an observation approach to treatment of vestibular schwannoma, about 31% may eventually undergo further treatment. Of those followed for 5 to 10 years, 18% eventually had further treatment. However, some patients are followed with radiologic evaluations for many years without necessity for further treatment.
评估接受保守治疗的前庭神经鞘瘤患者肿瘤生长的长期发生率以及进一步治疗的需求。
回顾性病历审查。
私立神经耳科三级转诊中心。
接受保守治疗且此前已进行研究的前庭神经鞘瘤患者（N = 114）。距上次磁共振成像的平均时间为4.8年，距上次随访的平均时间为6.4年（最长18.5年）。
采用钆增强磁共振成像进行连续检查并测量肿瘤大小。
最大肿瘤直径变化2毫米或更大（生长）、进一步治疗、听力学指标——纯音平均听阈、言语识别率、美国耳鼻咽喉头颈外科学会（AAO - HNS）听力分级。
38%的肿瘤出现生长；平均生长6.5毫米（标准差3.8），平均生长速率为每年3.1毫米。在1年或更短时间内无生长的患者中，20%在末次随访时出现生长。总体而言，平均3.8年后（标准差3.5；最长18.5年），31%的患者接受了进一步治疗。在随访5至10年的患者中，18%最终接受了进一步治疗。在末次随访时，仅56%生长的肿瘤接受了进一步治疗；14.8%未生长的肿瘤也接受了进一步治疗。生长的肿瘤纯音平均听阈下降幅度（平均变化量 = 28.8分贝）大于未生长的肿瘤（平均变化量 = 16.5分贝）（p≤0.025），但听力变化量与肿瘤大小之间无相关性。初始AAO - HNS听力分级为A类的患者中，85.7%保留了有用听力。
对于选择观察性治疗方法的前庭神经鞘瘤患者，约31%最终可能接受进一步治疗。在随访5至10年的患者中，18%最终接受了进一步治疗。然而，一些患者接受了多年的影像学评估却无需进一步治疗。
