Peng K A, Wilkinson E P
House Clinic,Los Angeles,California,USA.
J Laryngol Otol. 2016 Jul;130(7):606-10. doi: 10.1017/S0022215116007969. Epub 2016 May 20.
To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.
The Medline database was searched for publications that included the terms 'vestibular schwannoma' and/or 'acoustic neuroma', occurring in conjunction with 'hearing'. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.
Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.
In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.
对显微手术在伴有可用听力的小型前庭神经鞘瘤治疗中相对于观察和立体定向放射治疗的作用进行系统评价。
在Medline数据库中检索包含“前庭神经鞘瘤”和/或“听神经瘤”以及“听力”的出版物。人工筛选文章以识别那些关于最大直径小于1.5厘米的前庭神经鞘瘤的文章。此后，仅考虑讨论术前和术后听力的出版物。
共识别出26篇论文。对于生长缓慢且不考虑听力保留的小肿瘤，观察是一种可接受的策略。相比之下，显微手术，包括中颅窝入路，可能会提供出色的听力结果，特别是当小肿瘤已开始导致听力损失时。术后即刻听力通常可预测长期听力。关于立体定向放射治疗的最新数据表明，确定性治疗后听力会长期恶化。
对于65岁以下患有小型前庭神经鞘瘤的患者，通过中颅窝入路进行显微手术可持久保留听力。
