Borsetto Daniele, Gair Juliette, Kenyon Olivia, Das Tilak, Donnelly Neil, Axon Patrick, Macfarlane Robert, Mannion Richard, Scoffings Daniel, Bance Manohar, Tysome James
Department of Skull Base Surgery, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom.
Department of Ear, Nose & Throat, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom.
J Neurol Surg B Skull Base. 2019 Aug;80(4):333-337. doi: 10.1055/s-0038-1676820. Epub 2018 Dec 27.
Observation is a well-accepted management for small- to medium-sized vestibular schwannomas (VSs). Although there are good data on the natural history of this disease within adults, no studies have looked specifically at those aged over 70 years. Thus, there is a need for a surveillance protocol to determine if and when we can stop imaging safely patients aged 70 years and over with a new diagnosis of VSs when managed with observation. Over a 13-year period, we retrospectively analyzed all skull base unit patients with a sporadic unilateral VSs managed with an imaging surveillance protocol. All data were collected prospectively with a minimum follow-up of 5 years. Tertiary referral skull base unit Patients aged 70 years and over with sporadic VSs at diagnosis Main outcome measures A total of 112 patients met inclusion criteria. The median age at diagnosis was 74 years (range: 70-87 years). The mean follow-up was 82 months (range: 60-144). The size of the VSs at diagnosis was intracanalicular (IC) in 46%, small in 41%, medium in 12%, and large in 2%. Growth was more likely where tumors were extracanalicular (EC) rather than IC at presentation ( = 0.036) and within the first 18 months after diagnosis ( < 0.001). Twenty-nine percent of VSs displayed growth (6% continued surveillance, 23% received active treatment). Good hearing at diagnosis did not predict tumor stability for IC or EC tumors ( = 0.162 and = 0.536). Since no VSs grew after 42 months from diagnosis, our data support an initial magnetic resonance imaging (MRI) at 6 months after diagnosis followed by an annual MRI for 3 years. At this point, consideration could be given to discussing discontinuation or further imaging with patients.
观察是中小型前庭神经鞘瘤（VS）广泛接受的治疗方式。虽然已有关于该疾病在成人中的自然病史的可靠数据，但尚无研究专门针对70岁以上人群。因此，需要一种监测方案来确定，对于新诊断为VS且采用观察治疗的70岁及以上患者，能否以及何时可以安全地停止影像学检查。
在13年期间，我们回顾性分析了所有采用影像学监测方案治疗的散发单侧VS的颅底单位患者。所有数据均前瞻性收集，随访时间至少5年。
三级转诊颅底单位
诊断时年龄在70岁及以上的散发VS患者
主要观察指标
共有112例患者符合纳入标准。诊断时的中位年龄为74岁（范围：70 - 87岁）。平均随访时间为82个月（范围：60 - 144个月）。诊断时VS的大小为内听道内（IC）型占46%，小型占41%，中型占12%，大型占2%。肿瘤在初诊时为外耳道外（EC）而非IC型（P = 0.036）以及诊断后的前18个月内（P < 0.001）更有可能生长。29%的VS出现生长（6%继续监测，23%接受积极治疗）。诊断时听力良好并不能预测IC或EC肿瘤的稳定性（P = 0.162和P = 0.536）。
由于自诊断后42个月起没有VS生长，我们的数据支持在诊断后6个月进行首次磁共振成像（MRI）检查，随后每年进行一次MRI检查，持续3年。此时，可以考虑与患者讨论是否停止检查或进一步进行影像学检查。
