Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
Department of Otolaryngology-Head and Neck Surgery, Military Hospital, Hisar, India.
Neurosurgery. 2018 Nov 1;83(5):858-870. doi: 10.1093/neuros/nyx568.
The wait-and-scan modality has emerged as an important strategy in the management of vestibular schwannoma (VS) as it has been demonstrated that many tumors grow slowly or do not show any growth over long periods.
To analyze long-term outcomes of wait-and-scan in the treatment of patients with VS, discuss the factors contributing to the decision making, determine the inherent risks of the policy, and compare our results with literature.
In total, 576 patients with sporadic unilateral VS who were managed with wait-and-scan were reviewed retrospectively. Of these, a subset of 154 patients with 5-yr follow-up was separately analyzed. The tumor characteristics including patterns of growth, rate of growth, hearing outcomes, and likely factors affecting the above parameters were analyzed.
The mean period of follow-up was 36.9 ± 30.2 mo. The mean age was 59.2 ± 11.6 yr. Thirteen different patterns of tumor growth were observed. Eighty-four (54.5%) of 154 tumors with 5-yr follow-up showed no growth throughout 5 yr. Fifty-six (36.4%) tumors showed mixed growth rates. Only 57 (37%) patients had serviceable hearing at the start of follow-up, but 32 (56.1%) maintained it at the end of follow-up. One hundred fifty (26%) of the 576 patients who failed wait-and-scan had to be taken up for surgery.
While there may be no price to pay in wait-and-scan as far as hearing is concerned, this may not be the case for facial nerve outcomes, wherein the results may be better if the patients are taken earlier for surgery.
等待观察模式已成为听神经瘤（VS）管理的重要策略，因为已经证明许多肿瘤生长缓慢或在很长一段时间内没有任何生长。
分析等待观察治疗 VS 患者的长期结果，讨论影响决策的因素，确定该策略的固有风险，并将我们的结果与文献进行比较。
回顾性分析了 576 例接受等待观察治疗的散发性单侧 VS 患者，其中 154 例有 5 年随访的患者被单独分析。分析了肿瘤特征，包括生长模式、生长速度、听力结果以及可能影响上述参数的因素。
平均随访时间为 36.9 ± 30.2 个月。平均年龄为 59.2 ± 11.6 岁。观察到 13 种不同的肿瘤生长模式。154 例有 5 年随访的肿瘤中，84 例（54.5%）在 5 年内无生长。56 例（36.4%）肿瘤生长速度混合。只有 57 例（37%）患者在随访开始时具有可利用的听力，但 32 例（56.1%）在随访结束时保持了听力。150 例（26%）等待观察失败的 576 例患者需要接受手术。
尽管在听力方面等待观察可能没有代价，但在面神经结果方面可能并非如此，如果患者更早接受手术，结果可能会更好。
