Department of Neurosurgery, Northwell Neuroscience Institute, North Shore University Hospital, 300 Community Dr. 9T, Manhasset, NY, 11030, USA.
Department of Otolaryngology, North Shore University Hospital, Manhasset, NY, USA.
Acta Neurochir (Wien). 2018 Nov;160(11):2263-2275. doi: 10.1007/s00701-018-3674-x. Epub 2018 Sep 18.
Currently, there is no consensus in the initial management of small vestibular schwannomas (VSs). They are routinely watched and/or referred for radiosurgical treatment, although surgical removal is also an option. We hereby evaluate clinical outcomes of patients who have undergone surgical removal of smaller symptomatic VSs.
Patients with vestibular schwannomas (grade T1-T3b according to Hannover classification) were reviewed. Patients with symptomatic tumors who underwent surgery were evaluated. Their preoperative hearing status was based on the guideline of the committee on hearing and equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) foundation. Their postoperative facial nerve function, hearing status, vestibular symptoms, and degree of tumor resection were assessed.
Thirty patients were selected for surgery via a retrosigmoid approach based on their age, symptoms, and their own decision-making after discussion of management options. Most patients presented with hearing loss. Seventeen patients had useful hearing preoperatively. Among them, 10 patients (59%) preserved useful hearing (class A or B) postoperatively. MRI at 1-year follow-up confirmed complete resection in 26/29 patients. Also, 29 patients (97%) had HB grade I-II, and 1 patient had HB III at 1-year follow-up. Except for 1 patient with CSF leak, 1 patient with delayed facial nerve palsy, and 2 patients with asymptomatic sigmoid sinus occlusion, there were no other new morbidities.
Although both observation and radiosurgery are valid options in the management of smaller size vestibular schwannomas, surgical treatment seems to offer a high rate of facial nerve preservation, a reasonable rate of hearing sparing, and a high total resection rate. Clinicians should consider surgical treatment as a valid option in the initial management of symptomatic small vestibular schwannomas in younger patients.
目前，对于小前庭神经鞘瘤（VSs）的初始管理尚无共识。尽管手术切除也是一种选择，但它们通常被观察和/或转介进行放射外科治疗。在此，我们评估了接受较小症状性 VS 手术切除的患者的临床结果。
回顾了前庭神经鞘瘤（根据 Hannover 分类为 T1-T3b 级）患者。评估了有症状肿瘤且接受手术的患者。他们术前的听力状况是基于美国耳鼻喉科学-头颈外科学会（AAO-HNS）基金会听力和平衡委员会的指南。评估了他们术后的面神经功能、听力状况、前庭症状和肿瘤切除程度。
根据年龄、症状以及在讨论管理方案后自己的决策，通过乙状窦后入路选择 30 名患者进行手术。大多数患者表现为听力下降。术前有 17 名患者有有用听力。其中，10 名患者（59%）术后保留了有用听力（A级或 B 级）。1 年随访的 MRI 证实 29 例患者完全切除。此外，29 例患者（97%）在 1 年随访时为 HB I-II 级，1 例患者为 HB III 级。除了 1 例患者有脑脊液漏、1 例患者有延迟性面神经瘫痪和 2 例患者无症状的乙状窦闭塞外，没有其他新的并发症。
尽管观察和放射外科都是治疗较小前庭神经鞘瘤的有效选择，但手术治疗似乎提供了高面神经保留率、合理的听力保留率和高总切除率。临床医生应考虑将手术治疗作为年轻患者有症状小前庭神经鞘瘤初始治疗的有效选择。
