Nguyen Thien, Duong Courtney, Sheppard John P, Lee Seung Jin, Kishan Amar U, Lee Percy, Tenn Stephen, Chin Robert, Kaprealian Tania B, Yang Isaac
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States; David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States.
Clin Neurol Neurosurg. 2018 Mar;166:116-123. doi: 10.1016/j.clineuro.2018.01.005. Epub 2018 Jan 12.
Vestibular schwannomas (VS) are benign tumors stemming from the eighth cranial nerve. Treatment options for VS include conservative management, microsurgery, stereotactic radiosurgery, and fractionated radiotherapy. Though microsurgery has been the standard of care for larger lesions, hypo-fractionated stereotactic radiotherapy (hypo-FSRT) is an emerging modality. However, its clinical efficacy and safety have yet to be established. We conducted a systematic review and meta-analysis of manuscripts indexed in PubMed, Scopus, Web of Science, Embase, and Cochrane databases reporting outcomes of VS cases treated with hypo-FSRT. Five studies representing a total of 228 patients were identified. Across studies, the pooled rates of tumor control, hearing, facial nerve, and trigeminal nerve preservation were 95%, 37%, 97%, and 98%. No instances of malignant induction were observed at median follow-up of 34.8 months. Complications included trigeminal neuropathy (n = 3), maxillary paresthesia (n = 1), neuralgia (n = 1), vestibular dysfunction (n = 1), radionecrosis (n = 1), and hydrocephalus (n = 1). Hypo-FSRT may be another useful approach to manage VS, but studies with extended follow-up times are required to establish long-term safety.
前庭神经鞘瘤（VS）是起源于第八对脑神经的良性肿瘤。VS的治疗选择包括保守治疗、显微手术、立体定向放射外科和分次放射治疗。尽管显微手术一直是较大病变的标准治疗方法，但低分割立体定向放射治疗（hypo-FSRT）是一种新兴的治疗方式。然而，其临床疗效和安全性尚未得到证实。我们对PubMed、Scopus、Web of Science、Embase和Cochrane数据库中索引的报告hypo-FSRT治疗VS病例结果的手稿进行了系统评价和荟萃分析。共纳入5项研究，涉及228例患者。在各项研究中，肿瘤控制、听力保留、面神经保留和三叉神经保留的合并率分别为95%、37%、97%和98%。在34.8个月的中位随访期内未观察到恶性诱导病例。并发症包括三叉神经病变（n = 3）、上颌感觉异常（n = 1）、神经痛（n = 1）、前庭功能障碍（n = 1）、放射性坏死（n = 1）和脑积水（n = 1）。Hypo-FSRT可能是另一种治疗VS的有效方法，但需要进行更长随访时间的研究来确定其长期安全性。
