Department of Otorhinolaryngology.
Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.
Otol Neurotol. 2019 Sep;40(8):1088-1093. doi: 10.1097/MAO.0000000000002312.
To assess how pretreatment vestibular schwannoma (VS) tumor characteristics are associated with vestibular symptoms after gamma knife (GK) surgery.
Retrospective chart review of patients undergoing GK treatment for VS at our institution from 2005 to 2018.
Academic tertiary referral center.
Patients receiving primary GK surgery for vestibular schwannomas with at least 6 months of follow up. Patients with neurofibromatosis 2 or previous surgery were excluded.
The presence of posttreatment vestibular symptoms within 6 months after GK. Clinical records were assessed for pretreatment tumor, patient, and treatment characteristics that impacted posttreatment symptoms.
All patients received radiation doses between 12 and 13 Gy. Of 115 patients, the average age was 60. Thirty-seven (32%) patients developed vestibular symptoms within 6 months post-GK, and 18 patients were referred for vestibular rehabilitation. Ten of 13 patients undergoing vestibular rehabilitation reported improvement. Overall, 112 patients had tumor measurements. Pretreatment tumors were significantly smaller for patients with acute vestibular symptoms (mean 1.43 cm versus 1.71 cm, p = 0.007). On multivariate analysis, smaller tumor size (p = 0.009, odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12-0.73]) was significantly associated with vestibular symptoms within 6 months of GK. Patients with tumors less than 1.6 cm were more likely to receive referrals for vestibular rehabilitation within 6 months posttreatment (25% versus 9.4%, p = 0.026, OR = 3.22, 95% CI [1.00, 11.32]).
Smaller vestibular schwannomas were significantly associated with higher rates of post-GK vestibular symptoms. Pretreatment tumor size may be used to counsel patients on the likelihood of post-GK vestibular symptoms and vestibular rehabilitation.
评估预处理前庭神经鞘瘤（VS）肿瘤特征与伽玛刀（GK）手术后前庭症状的关系。
对 2005 年至 2018 年在我院接受 GK 治疗的 VS 患者的病历进行回顾性分析。
学术三级转诊中心。
接受原发性 GK 手术治疗的前庭神经鞘瘤患者，随访时间至少 6 个月。排除神经纤维瘤病 2 型或既往手术患者。
GK 治疗后 6 个月内出现治疗后前庭症状。评估治疗前肿瘤、患者和治疗特征对治疗后症状的影响。
所有患者接受的放射剂量为 12 至 13 Gy。115 例患者中，平均年龄为 60 岁。37 例（32%）患者在 GK 治疗后 6 个月内出现前庭症状，18 例患者接受了前庭康复治疗。13 例接受前庭康复治疗的患者中有 10 例报告症状改善。共有 112 例患者进行了肿瘤测量。急性前庭症状患者的肿瘤明显较小（平均 1.43cm 与 1.71cm，p=0.007）。多变量分析显示，肿瘤较小（p=0.009，比值比[OR]为 0.29，95%置信区间[CI]为 0.12-0.73）与 GK 治疗后 6 个月内出现前庭症状显著相关。肿瘤小于 1.6cm 的患者在治疗后 6 个月内更有可能接受前庭康复治疗（25%与 9.4%，p=0.026，OR 为 3.22，95%CI [1.00，11.32]）。
较小的前庭神经鞘瘤与 GK 后更高的前庭症状发生率显著相关。治疗前肿瘤大小可用于向患者提供 GK 后前庭症状和前庭康复的可能性的咨询。
