Kirchmann Malene, Karnov Kirstine, Hansen Søren, Dethloff Thomas, Stangerup Sven-Eric, Caye-Thomasen Per
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Neurosurgery. 2017 Jan 1;80(1):49-56. doi: 10.1227/NEU.0000000000001414.
Reports on the natural history of tumor growth and hearing in patients with a vestibular schwannoma (VS) are almost exclusively short-term data. Long-term data are needed for comparison with results of surgery and radiotherapy.
To report the long-term occurrence of tumor growth and hearing loss in 156 patients diagnosed with an intracanalicular VS and managed conservatively.
In this longitudinal cohort study, diagnostic and follow-up magnetic resonance imaging and audiometry were compared.
After a follow-up of 9.5 years, tumor growth had occurred in 37% and growth into the cerebellopontine angle had occurred in 23% of patients. Conservative treatment failed in 15%. The pure tone average had increased from 51- to 72-dB hearing level, and the speech discrimination score (SDS) had decreased from 60% to 34%. The number of patients with good hearing (SDS > 70%) was reduced from 52% to 22%, and the number of patients with American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A hearing was reduced from 19% to 3%. Hearing was preserved better in patients with 100% SDS at diagnosis than in patients with even a small loss of SDS. Serviceable hearing was preserved in 34% according to AAO-HNS (class A-B) and in 58% according to the word recognition score (class I-II). Rate of hearing loss was higher in patients with growing tumors.
Tumor growth occurred in only a minority of patients diagnosed with an intracanalicular VS during 10 years of observation. The risk of hearing loss is small in patients with normal discrimination at diagnosis. Serviceable hearing is preserved spontaneously in 34% according to AAO-HNS and in 58% according to the word recognition score.
关于前庭神经鞘瘤（VS）患者肿瘤生长和听力自然史的报告几乎都是短期数据。需要长期数据来与手术和放疗结果进行比较。
报告156例诊断为内耳道VS且接受保守治疗患者的肿瘤生长和听力损失的长期发生情况。
在这项纵向队列研究中，对诊断性和随访性磁共振成像及听力测定进行了比较。
随访9.5年后，37%的患者出现肿瘤生长，23%的患者肿瘤长入桥小脑角。15%的保守治疗失败。纯音平均听阈从51dB听力级提高到72dB听力级，言语辨别得分（SDS）从60%降至34%。听力良好（SDS>70%）的患者数量从52%降至22%，美国耳鼻咽喉头颈外科学会（AAO-HNS）A级听力的患者数量从19%降至3%。诊断时SDS为100%的患者听力保存情况优于SDS即使有轻微损失的患者。根据AAO-HNS标准，34%的患者保留了有效听力（A-B级），根据言语识别得分标准，58%的患者保留了有效听力（I-II级）。肿瘤生长的患者听力损失发生率更高。
在10年的观察期内，仅少数诊断为内耳道VS的患者出现肿瘤生长。诊断时辨别能力正常的患者听力损失风险较小。根据AAO-HNS标准，34%的患者自发保留了有效听力，根据言语识别得分标准，58%的患者自发保留了有效听力。
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