Fusco Matthew R, Fisher Winfield S, McGrew Benjamin M, Walters Beverly C
UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA.
UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA.
Clin Neurol Neurosurg. 2014 Dec;127:143-8. doi: 10.1016/j.clineuro.2014.10.002. Epub 2014 Oct 12.
Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions.
A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach.
Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance.
The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada.
在过去的五十年里，前庭神经鞘瘤的综合治疗发生了巨大变化。以前，神经外科医生最有可能通过独立的手术方法来治疗这些肿瘤。目前，许多神经外科医生采用与神经耳科医生和放射肿瘤学家组成的跨学科团队方法来治疗前庭神经鞘瘤。这项调查旨在确定美国和加拿大神经外科医生目前对前庭神经鞘瘤的治疗模式，尤其关注采用团队方法进行这些病变手术切除的情况。
通过电子邮件向目前在美国或加拿大执业的、接受过住院医师培训的美国神经外科医师协会成员发送了一份包含十七个部分的调查问卷。问题分为几组，涉及医生背景、总体执业经历、近期执业经历、对治疗模式的看法以及跨学科团队方法的经验。
共收到706份回复。绝大多数神经外科医生作为跨学科团队的一员进行前庭神经鞘瘤的手术切除（85.7%）。在跨学科团队的使用方面观察到区域差异：目前在南方执业的、在没有神经耳科医生参与的情况下进行前庭神经鞘瘤手术治疗的回复神经外科医生占52.3%（没有其他地区在该组中的占比超过15.4%，p = 0.02）。治疗过超过50例前庭神经鞘瘤的外科医生比经验较少的外科医生更倾向于更频繁地采用跨学科方法，但这未达到统计学意义。
美国和加拿大的大多数神经外科医生通过在神经耳科医生参与下的跨学科方法进行前庭神经鞘瘤的手术切除。与美国和加拿大其他地区的神经外科医生相比，南方的神经外科医生似乎更有可能单独进行这些肿瘤的手术治疗。
