Younes Elias, Montava Marion, Bachelard-Serra Mathilde, Jaloux Laurent, Salburgo Florent, Lavieille Jean Pierre
*Faculty of Medical Science, Lebanese University, Beirut, Lebanon †ENT-Head and Neck Surgery Department, Hospital la Conception, APHM ‡Aix Marseille University, IFSSTAR, LBA, Marseille, France.
Otol Neurotol. 2017 Oct;38(9):1345-1350. doi: 10.1097/MAO.0000000000001538.
There is no consensus about the use of observation as a therapeutic modality for intracanalicular vestibular schwannoma (ICVS). The objective of this study was to describe tumor evolution, its correlation with initial size, stage of vestibular schwannoma, clinical presentation and to propose a risk classification for tumor growth with a therapeutic decision algorithm.
Fifty-three patients with ICVS were followed prospectively from 2010 to 2015. The mean follow-up was 32 months. Patients underwent clinical examination, audiogram, magnetic resonance imaging at 6, 12, and then 12 months intervals within the first 5 years of initial diagnosis. We analyzed the patient's clinical course, audiologic changes, initial tumor location, and correlation of different parameters with ICVS growth.
Fourteen patients (26%) deteriorated their hearing level and 17 patients (27%) showed tumor growth during the follow-up period. Growth was noted during the first year of observation in 13 patients (76.5%). Considering initial presentation: tumor size, intracanalicular staging, and hearing level, patients with larger vestibular schwannoma, extension to the fundus regardless of tumor size, higher initial pure-tone average, and speech recognition test showed a significantly higher rate of tumor growth. ICVS evolution was not correlated with hearing deterioration with time.
We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS.
对于将观察作为管内型前庭神经鞘瘤（ICVS）的一种治疗方式，目前尚无共识。本研究的目的是描述肿瘤的演变、其与初始大小、前庭神经鞘瘤分期、临床表现的相关性，并通过治疗决策算法提出肿瘤生长的风险分类。
对2010年至2015年期间的53例ICVS患者进行前瞻性随访。平均随访时间为32个月。患者在初次诊断后的前5年内，每隔6个月、12个月，然后每隔12个月接受临床检查、听力图检查和磁共振成像检查。我们分析了患者的临床病程、听力变化、初始肿瘤位置以及不同参数与ICVS生长的相关性。
14例患者（26%）听力水平下降，17例患者（27%）在随访期间出现肿瘤生长。13例患者（76.5%）在观察的第一年出现生长。考虑初始表现：肿瘤大小、管内分期和听力水平，前庭神经鞘瘤较大、无论肿瘤大小均延伸至底部、初始纯音平均值较高以及言语识别测试结果较差的患者，肿瘤生长率显著更高。ICVS的演变与听力随时间的恶化无关。
我们应将观察视为一种治疗方式。我们验证了管内分期作为预后因素，并提出将患者分为低、中、高潜在肿瘤生长风险类别，以指导ICVS的初始管理。
