Tang Shan, Griffin Andrew S, Waksal Julian A, Phillips C Douglas, Johnson Carl E, Comunale Joseph P, Karimi Sasan, Powell Tiffany L, Stieg Philip E, Gutin Philip H, Brown Kevin D, Sheehan Matthew, Selesnick Samuel H
*Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York; †Department of Medicine, Weill Cornell Medical College, New York, New York; ‡Tufts University School of Medicine, Boston, Massachusetts; §Department of Radiology, Weill Cornell Medical College, New York, New York; ∥Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; ¶Department of Neurosurgery, George Washington University School of Medicine, Washington DC; #Department of Neurological Surgery, Weill Cornell Medical College, New York, New York; **Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York; ††Weill Cornell Medical College, New York, New York; ‡‡Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York; and §§Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Otol Neurotol. 2014 Aug;35(7):1271-6. doi: 10.1097/MAO.0000000000000459.
To compare different methods of measuring tumor growth after resection of vestibular schwannoma and to identify predictors of growth.
Retrospective case review.
Tertiary referral center, inpatient surgery with ambulatory follow-up.
All patients who underwent vestibular schwannoma resection by the senior author from September 1991 to April 2012 and had two or more postoperative MRI scans.
Vestibular schwannoma resection. Measurement of tumor size and enhancement pattern on postoperative magnetic resonance imaging scans.
Tumor size as measured in one (linear), two (planar), and three (volumetric) dimensions using standard radiology workstation tools versus time elapsed since surgical resection.
Eighty-eight patients were included with mean follow-up of 3.9 years. Linear measurement of tumor size was found to have modest correlation with planar and volumetric measurements. Excellent correlation was found between the planar and volumetric methods. Nodular enhancement increased risk for tumor growth (OR 6.25, p = 0.03 on planar analysis). If there was growth, tumors with nodular enhancement typically showed increase in size beginning 2 years postoperatively, whereas those with linear or no enhancement were typically stable in size through 5 years. Younger age and larger preoperative tumor size were also risk factors for growth (OR 0.9/p = 0.01 and OR 1.09/p = 0.02).
Simple planar measurement is an efficient method that correlates well with the more time-consuming volumetric method. The major risk factor for tumor growth is nodular enhancement on a baseline scan, a finding that warrants annual MRI beginning 2 years postoperatively. Younger age and larger preoperative size minimally increased risk of growth.
比较前庭神经鞘瘤切除术后测量肿瘤生长的不同方法，并确定生长的预测因素。
回顾性病例分析。
三级转诊中心，住院手术及门诊随访。
1991年9月至2012年4月由资深作者进行前庭神经鞘瘤切除术且术后有两次或更多次MRI扫描的所有患者。
前庭神经鞘瘤切除术。术后磁共振成像扫描测量肿瘤大小及强化模式。
使用标准放射学工作站工具在一维（线性）、二维（平面）和三维（体积）测量肿瘤大小与手术切除后经过的时间。
纳入88例患者，平均随访3.9年。发现肿瘤大小的线性测量与平面和体积测量有适度相关性。平面和体积测量方法之间有极好的相关性。结节状强化增加肿瘤生长风险（平面分析时OR为6.25，p = 0.03）。如果有生长，结节状强化的肿瘤通常在术后2年开始显示大小增加，而线性强化或无强化的肿瘤在5年内大小通常稳定。年轻和术前肿瘤较大也是生长的危险因素（OR 0.9/p = 0.01和OR 1.09/p = 0.02）。
简单的平面测量是一种有效的方法，与更耗时的体积测量方法相关性良好。肿瘤生长的主要危险因素是基线扫描时的结节状强化，这一发现表明术后2年起需每年进行MRI检查。年轻和术前肿瘤较大对生长风险的增加极小。
