Neurosurgery of Neurocenter, Kuopio University Hospital and Clinical Institute, University of Eastern Finland, P.O.B 100, 70029 KYS,, Kuopio, Finland.
Neurosurgery, Assiut University Hospital and Faculty of Medicine, Assiut University, Assiut, Egypt.
Acta Neurochir (Wien). 2020 Jan;162(1):43-54. doi: 10.1007/s00701-019-04055-4. Epub 2019 Sep 7.
Vestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. We report the results of VS surgery in a population-based unselected cohort in a center with access to Cyber Knife (CK) radiosurgery.
We reviewed 117 consecutive operations and found 95 patients who had their primary operation due to vestibular schwannoma between 2001 and 2017. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification.
The population consisted of 37 males and 58 females with a median age of 54 years (range 19-79). One year after surgery 67% of patients had a good outcome (HB 1-2). The rate of good outcome was 90% if no facial nerve damage was observed during intraoperative monitoring, the size of the tumor was under 30 mm and no hydrocephalus was present. During the study period, the treatment strategy changed from total to near-total resection after the introduction of CK radiosurgery, which could be used as a second-line treatment in case of residual tumor regrowth. This resulted in an improvement of outcomes (0% HB 5-6) despite the larger tumor sizes (25 ± 14 mm vs. 31 ± 9 mm, p < 0.05). Hearing preservation rates did not increase.
Near-total resection and subsequent CK radiosurgery in case of residual tumor regrowth during follow-up seems to provide a good outcome of facial nerve function even in large VSs.
前庭神经鞘瘤（VS）是一种起源于前庭耳蜗神经的良性肿瘤。由于手术可能导致医源性面神经损伤，因此最佳治疗策略存在争议。我们报告了在一个有 Cyber Knife（CK）放射外科治疗的中心，对一个基于人群的未经选择的队列中 VS 手术的结果。
我们回顾了 117 例连续手术，发现 95 例患者在 2001 年至 2017 年间因前庭神经鞘瘤接受了首次手术。面神经功能采用 House-Brackmann（HB）量表进行评估，听力采用 EU 分类进行评估。
该人群由 37 名男性和 58 名女性组成，中位年龄为 54 岁（范围 19-79 岁）。手术后 1 年，67%的患者有良好的结果（HB 1-2）。如果术中监测未发现面神经损伤、肿瘤大小小于 30mm 且无脑积水，则良好结果的发生率为 90%。在研究期间，治疗策略从全切除改为 CK 放射外科治疗后，在出现残余肿瘤复发的情况下可作为二线治疗，这导致了更好的结果（尽管肿瘤更大，但 HB 5-6 为 0%）（0% HB 5-6）。尽管肿瘤更大（25±14mm 比 31±9mm，p<0.05），但听力保留率并未增加。
在随访中，如果出现残余肿瘤复发，行近全切除和随后的 CK 放射外科治疗，即使在大 VS 中，似乎也能提供良好的面神经功能预后。
