Lee Hyun-Jin, Kim Mi Joo, Koh Seung Hyun, Chang Won Seok, Moon In Seok
*Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Changwon †Department of Otorhinolaryngology, Catholic Kwandong University International St. Mary's Hospital, Incheon ‡Choi Ko ENT, Jeju §Department of Neurosurgery ||Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Otol Neurotol. 2017 Oct;38(9):1339-1344. doi: 10.1097/MAO.0000000000001536.
The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence.
Retrospective chart review.
Tertiary center.
Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled.
Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared.
Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function.
Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.
原发性伽玛刀放射外科治疗（GKS）用于前庭神经鞘瘤（VS）的情况日益增多，这使得因GKS治疗失败而需要挽救性手术的患者数量随之增加。当患者接受GKS作为主要治疗方法时，已知在挽救性手术中从相邻神经分离肿瘤更加困难。在本报告中，我们分享此类患者的临床经验，并分析肿瘤复发/再生长患者的临床发现。
回顾性病历审查。
三级医疗中心。
纳入9例因GKS或显微手术后VS复发/再生长而接受挽救性手术的患者。
对症状进展、影像学变化、术中发现及手术结果进行评估和比较。
6例曾接受GKS治疗和3例曾接受显微手术治疗的患者接受了挽救性显微手术。肿瘤再生长最明显的症状是听力损失加重。所有患者的挽救性手术均局限于通过经迷路/经耳道入路进行次全或近全切除。与既往显微手术组相比，GKS组中严重粘连、增厚和纤维化更为显著。在GKS组中，从面神经分离肿瘤比显微手术患者更困难。尽管所有6例患者（GKS组3例，翻修显微手术组无）的面神经在解剖学上得以保留，但GKS组有3例患者面神经功能恶化。
GKS治疗失败后VS的挽救性显微手术比翻修显微手术更困难，且面神经预后相对较差。因此，应谨慎选择VS的主要治疗方法。对于接受GKS治疗后听力损失突然变化的患者，建议进行额外的影像学检查。
