Johnson Stephen, Kano Hideyuki, Faramand Andrew, Niranjan Ajay, Flickinger John C, Lunsford L Dade
Departments of1Neurological Surgery and.
3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Neurosurg. 2019 Sep 6;133(4):1235-1241. doi: 10.3171/2019.5.JNS182765. Print 2020 Oct 1.
Optimizing outcomes in the management of patients with vestibular schwannomas (VSs) requires consideration of the patient's goals. Earlier recognition of VS by imaging has led to an evolution in management. Stereotactic radiosurgery (SRS) has emerged as a frequently used strategy designed to reduce management risks, obtain long-term tumor control, and preserve current neurological function. The authors analyzed features that impact hearing preservation rates in patients with serviceable hearing prior to SRS.
The study included 307 patients who had serviceable hearing (Gardner-Robertson hearing scale [GR] grade 1 or 2, speech discrimination score ≥ 50%, pure tone average ≤ 50 dB) at the time of SRS. The authors evaluated parameters that included age, tumor volume, hearing status, disequilibrium, tinnitus, Koos class, sex, and tumor margin dose. The Pittsburgh Hearing Prediction Score (PHPS) was evaluated as a method to predict long-term hearing outcomes in these cases.
At a median of 7.6 years after SRS (range 1-23 years), tumor control was achieved in 95% of patients. The overall serviceable hearing preservation rate was 77.8% at 3 years, 68.8% at 5 years, and 51.8% at 10 years. The PHPS assigns a total of 5 points based on patient age (1 point if < 45 years, 2 points if 45-59 years, and 3 points if ≥ 60 years), tumor volume (0 points if < 1.2 cm3, 1 point if ≥ 1.2 cm3), and GR grade (0 points if grade 1 hearing, 1 point if grade 2 hearing) The serviceable hearing preservation rate was 92.3% at 10 years in patients whose score total was 1. In contrast, none of the patients whose PHPS was 5 maintained serviceable hearing at 10 years (p < 0.001).
SRS resulted in a high rate of long-term tumor control and cranial nerve preservation. The PHPS helped to predict long-term hearing preservation rates in patients who underwent SRS when they still had serviceable hearing. The best long-term hearing preservation rates were found in younger patients with smaller tumor volumes.
优化前庭神经鞘瘤（VS）患者的治疗效果需要考虑患者的目标。影像学对VS的早期识别已促使治疗方式发生演变。立体定向放射外科（SRS）已成为一种常用策略，旨在降低治疗风险、实现长期肿瘤控制并保留当前神经功能。作者分析了影响SRS治疗前仍有可用听力的患者听力保留率的因素。
该研究纳入了307例在SRS治疗时具有可用听力（Gardner-Robertson听力分级[GR]为1级或2级、言语辨别得分≥50%、纯音平均听阈≤50 dB）的患者。作者评估了包括年龄、肿瘤体积、听力状况、平衡失调、耳鸣、Koos分级、性别和肿瘤边缘剂量等参数。匹兹堡听力预测评分（PHPS）被评估为预测这些病例长期听力结果的一种方法。
在SRS治疗后的中位时间7.6年（范围1 - 23年），95%的患者实现了肿瘤控制。3年时总体可用听力保留率为77.8%，5年时为68.8%，10年时为51.8%。PHPS根据患者年龄（年龄<45岁得1分，45 - 59岁得2分，≥60岁得3分）、肿瘤体积（肿瘤体积<1.2 cm³得0分，≥1.2 cm³得1分）和GR分级（听力1级得0分，听力2级得1分）总共赋予5分。得分总计为1分的患者10年时可用听力保留率为92.3%。相比之下，PHPS为5分的患者在10年时无一例保留可用听力（p<0.001）。
SRS实现了较高的长期肿瘤控制率和颅神经保留率。PHPS有助于预测在仍有可用听力时接受SRS治疗的患者的长期听力保留率。在肿瘤体积较小的年轻患者中发现了最佳的长期听力保留率。
