1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania.
2Departments of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan.
J Neurosurg. 2018 Oct;129(4):928-936. doi: 10.3171/2017.5.JNS162894. Epub 2017 Nov 10.
For some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.
Nine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5-144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm (range 0.8-22.6 cm), and the median margin dose was 12.5 Gy (range 10-18 Gy). Patients with neurofibromatosis were excluded from this study.
The median follow-up was 51 months (range 6-266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm (p = 0.037) and non-dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5-38 months). Six patients underwent repeat SRS at a median of 64 months (range 44-134 months). Four patients underwent resection at a median of 14 months after SRS (range 8-30 months).
Stereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.
对于一些颈静脉孔神经鞘瘤（JFSs），完全切除是可能的，但可能会导致明显的发病率。立体定向放射外科（SRS）是 JFSs 显微手术的一种微创替代或辅助方法。作者回顾了 SRS 治疗这些肿瘤患者的临床和影像学结果。
国际伽玛刀研究基金会的 9 个参与中心确定了 92 名 1990 年至 2013 年间接受 SRS 治疗的患者。41 名患者接受了部分显微切除术。上次手术与 SRS 之间的中位间隔为 15 个月（范围 0.5-144 个月）。84 名患者有颅神经（CN）症状和体征。肿瘤体积中位数为 4.1cm（范围 0.8-22.6cm），边缘剂量中位数为 12.5Gy（范围 10-18Gy）。本研究排除了神经纤维瘤病患者。
中位随访时间为 51 个月（范围 6-266 个月）。47 名患者肿瘤消退，33 名患者肿瘤稳定，12 名患者肿瘤进展。3 年、5 年和 10 年的无进展生存率（PFS）分别为 93%、87%和 82%。在整个系列中，只有哑铃形（通过颈静脉孔向外延伸至颅外）与较差的 PFS 显著相关。在没有先前显微手术的患者组（n=51）中，与更好的 PFS 相关的因素包括肿瘤体积<6cm（p=0.037）和非哑铃形肿瘤（p=0.015）。27 名患者的颅神经病变改善，51 名患者稳定，14 名患者恶化。12%的患者在 SRS 后 1 年、24%在 2 年、27%在 3 年和 32%在 5 年时 CN 功能改善。7 名患者在 SRS 后中位 7 个月（范围 5-38 个月）出现症状性放射性不良反应。6 名患者在中位 64 个月（范围 44-134 个月）时行重复 SRS。4 名患者在 SRS 后中位 14 个月（范围 8-30 个月）时行切除术。
立体定向放射外科被证明是 JFSs 的一种安全有效的初始或辅助治疗方法。长期肿瘤控制率和 CN 功能的稳定或改善得到了证实。
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