Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.
Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A.
Laryngoscope. 2020 Feb;130(2):482-486. doi: 10.1002/lary.27950. Epub 2019 Apr 5.
To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan.
Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017.
In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78).
There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion.
NA Laryngoscope, 130:482-486, 2020.
评估目前前庭神经鞘瘤（VS）的诊断和治疗现状以及治疗趋势，并评估治疗方案中治疗环境和各种专家的作用。
诊断为 VS 的患者完成了一项自愿和匿名调查。调查问卷于 2017 年 1 月至 3 月通过听神经瘤协会网站、Facebook 页面和电子邮件时事通讯分发。
共有 789 名 VS 患者完成了调查。其中，414 人（52%）接受了手术；224 人（28%）接受了放射治疗；121 人（15%）进行了观察。普通耳鼻喉科医生诊断出 62%的应答者，其次是初级保健医生（11%）和神经耳科医生（10%）。与接受放射治疗或观察的患者相比，接受手术的患者年龄明显更小，肿瘤更大。1979 年至 2006 年期间，非手术与手术切除的患者比例从 1:2 变为 1:1，而 2007 年至 2017 年期间，该比例从 1:1 变为 1:1。神经外科医生（40%）和神经耳科医生（38%）在治疗讨论中最具影响力。神经耳科医生（P<0.001）和普通耳鼻喉科医生（P=0.04）在肿瘤较小的患者的决策过程中比神经外科医生更具影响力。在学术与非学术私立机构接受治疗的患者报告了相似的肿瘤大小（P=0.27）、治疗决策（P=0.09）和决策满意度（P=0.78）。
目前存在着一种持续的非手术治疗趋势，大约有一半的患者选择了非手术治疗。在这组患者中，患者通常表现为耳科症状，耳鼻喉科医生做出了最多的诊断。神经耳科医生和神经外科医生在治疗讨论中最具影响力。
无 喉科学，130：482-486，2020 年。
