Lagman Carlito, Voth Brittany L, Chung Lawrance K, Bui Timothy T, Lee Seung J, Barnette Natalie E, Gopen Quinton, Yang Isaac
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Acta Neurochir (Wien). 2017 Apr;159(4):739-750. doi: 10.1007/s00701-017-3076-5. Epub 2017 Jan 21.
Cerebellopontine angle (CPA) lipomas are rare, benign, slow-growing masses. Resections are considered in symptomatic patients who are refractory to targeted medical therapies, but at those stages the lipomas have often reached considerable sizes and encompass critical neurovascular structures. The objective of this study is to develop and to evaluate the utility of a scoring system for CPA lipomas. The hypothesis is that CPA lipomas with lower scores are probably best managed with early surgery.
The PubMed database was searched using relevant terms. Data on patient and lipoma characteristics were extracted and used to design a scoring system. CPA lipomas were stratified by scores with corresponding managements and outcomes analyzed.
One hundred and seventeen patients with CPA lipomas were identified and 40 CPA lipomas were scored. The remaining CPA lipomas were deficient in data and not scored. No lipomas were scored as 1. Score 2 lipomas (n = 12; 30%) most often underwent serial surveillances (n = 5; 41.6%), with the majority of symptoms remaining unimproved (n = 2; 40%). Patients with score 2 CPA lipomas treated with medical therapies (n = 3; 25%) often experienced symptom resolution (n = 2; 66.6%) (p = 0.0499). Patients with score 2 CPA lipomas undergoing surgical resections (n = 3; 25%) all experienced symptom resolution (n = 3; 100%) (p = 0.0499). Score 3 was most common (n = 16; 40%) and these lipomas were often surgically resected (n = 10; 62.5%). The majority of patients with score 3 CPA lipomas having undergone surgical resections (n = 10; 62.5%) experienced symptom improvement (n = 1; 10%) or resolution (n = 4; 40%).
Score 2 CPA lipomas are smaller and would be deemed non-surgical in general practice. However, our data suggest that these lipomas may benefit from either medical therapies or early surgical resections. The advantages of early surgery are maximal resection, decreased surgical morbidity, and improved symptom relief.
桥小脑角（CPA）脂肪瘤罕见、良性、生长缓慢。对于对靶向药物治疗无效的有症状患者可考虑手术切除，但在此阶段脂肪瘤往往已长得相当大，并累及关键的神经血管结构。本研究的目的是开发并评估一种CPA脂肪瘤评分系统的实用性。假设是得分较低的CPA脂肪瘤可能早期手术治疗效果最佳。
使用相关术语检索PubMed数据库。提取患者和脂肪瘤特征数据并用于设计评分系统。根据评分对CPA脂肪瘤进行分层，并分析相应的治疗方法和结果。
共识别出117例CPA脂肪瘤患者，其中40例CPA脂肪瘤进行了评分。其余CPA脂肪瘤数据不足未进行评分。没有脂肪瘤评分为1分。评分为2分的脂肪瘤（n = 12；30%）最常进行系列监测（n = 5；41.6%），大多数症状未改善（n = 2；40%）。接受药物治疗的评分为2分的CPA脂肪瘤患者（n = 3；25%）常症状缓解（n = 2；66.6%）（p = 0.0499）。接受手术切除的评分为2分的CPA脂肪瘤患者（n = 3；25%）均症状缓解（n = 3；100%）（p = 0.0499）。评分为3分最常见（n = 16；40%），这些脂肪瘤常接受手术切除（n = 10；62.5%）。接受手术切除的评分为3分的CPA脂肪瘤患者大多数（n = 10；62.5%）症状改善（n = 1；10%）或缓解（n = 4；40%）。
评分为2分的CPA脂肪瘤较小，在一般临床实践中通常被认为无需手术。然而，我们的数据表明这些脂肪瘤可能从药物治疗或早期手术切除中获益。早期手术的优势在于最大程度切除、降低手术并发症发生率以及改善症状缓解情况。
