Miller Mia E, Lin Harrison, Mastrodimos Bill, Cueva Roberto A
House Clinic, Los Angeles.
University of California Irvine, Irvine.
Laryngoscope. 2017 Sep;127(9):2132-2138. doi: 10.1002/lary.26525. Epub 2017 Mar 14.
To determine the optimal postoperative magnetic resonance imaging (MRI) schedule and length of follow-up for patients undergoing microsurgical excision of vestibular schwannoma (VS).
A retrospective review of patients who underwent microsurgical excision of VS at a single tertiary care center between January 1993 and March 2004.
Two hundred and twenty subjects were analyzed and characteristics gathered, including tumor size, surgical approach, completeness of resection, and length of follow-up to last MRI. All postoperative MRIs were reviewed. Radiologic progression is defined as a transition to a more advanced MRI grade from a less advanced MRI grade (eg, clean, linear, nodular) and was recorded for each of the subjects' serial MRIs. The MRI categorized findings were also binned into five time periods for summary analyses. Interval-censored survival analysis was performed to model time to recurrence across the population.
Of the non-neurofibromatosis type 2 (NF2) cohort, the average tumor size at the time of resection was 1.98 ± 1.02 cm (range 0.4-5 cm); average length of follow-up was 9.0 ± 4.6 years (range 1-19); 102 subjects (47.2%) underwent a retrosigmoid resection; and 110 (50.9%) underwent a translabyrinthine resection. Eight of these subjects (4.1%) demonstrated radiologic progression; of those, four underwent additional treatment. Survival analysis showed early (1-2 years postoperative), middle (2-10 years postoperative), and late (> 10 years postoperative) radiologic progression events.
The current recommended MRI surveillance schedule after microsurgery for VS includes MRIs at 1, 5, and 10 years postoperatively. Nonparametric survival analysis suggests that a majority of radiologic progression events occur in the first 10 years postoperatively.
确定接受前庭神经鞘瘤（VS）显微手术切除的患者术后最佳磁共振成像（MRI）检查时间表及随访时长。
对1993年1月至2004年3月期间在单一三级医疗中心接受VS显微手术切除的患者进行回顾性研究。
分析220名受试者并收集相关特征，包括肿瘤大小、手术入路、切除完整性以及至最后一次MRI检查的随访时长。对所有术后MRI检查结果进行回顾。放射学进展定义为从较低级别的MRI分级（如完全切除、线性、结节状）转变为更高级别的MRI分级，并记录每位受试者系列MRI检查的情况。MRI分类结果也被分为五个时间段进行汇总分析。进行区间删失生存分析以模拟整个人群的复发时间。
在非2型神经纤维瘤病（NF2）队列中，切除时肿瘤平均大小为1.98±1.02 cm（范围0.4 - 5 cm）；平均随访时长为9.0±4.6年（范围1 - 19年）；102名受试者（47.2%）接受了乙状窦后入路切除；110名（50.9%）接受了经迷路入路切除。其中8名受试者（4.1%）出现放射学进展；其中4名接受了额外治疗。生存分析显示存在早期（术后1 - 2年）、中期（术后2 - 十年）和晚期（术后>10年）放射学进展事件。
目前推荐的VS显微手术后MRI监测时间表包括术后1年、5年和10年进行MRI检查。非参数生存分析表明，大多数放射学进展事件发生在术后前10年。
4。《喉镜》，2017年，第127卷，第2132 - 2138页。
