Kleijwegt Maarten, Bettink Floris, Malessy Martijn, Putter Hein, van der Mey Andel
Department of ENT, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
J Neurol Surg B Skull Base. 2020 Feb;81(1):15-21. doi: 10.1055/s-0039-1678708. Epub 2019 Feb 4.
This study was aimed to determine the role of clinical presentation and tumor characteristics in vestibular schwannoma (VS) at diagnosis, initially treated with conservative management. The study was designed as a retrospective chart review. The study was prepared at national tertiary referral center for VS patients. A total of 836 VS patients, initially treated conservatively, were included. Patient characteristics: age at diagnosis, gender, frequency, and duration of, hearing loss, tinnitus, balance disorder (unsteadiness, dizziness, and vertigo), respectively; and tumor characteristics: laterality, growth, cystic component, and location were analyzed in relation to tumor size at diagnosis and change in treatment strategy. In total, 169 (20%) patients had a change in treatment strategy. Factors at diagnosis that had a high influence on intervention were a short duration of hearing loss (hazard ratio [HR]: 4.8, < 0.001) and cystic tumors (HR = 2.6, < 0.001). Balance disorders and extracanalicular (EC) tumor location have a medium influence on intervention (HR = 1.6, < 0.01). Tumour growth was seen in 55% of the intervention group; we found a significant correlation with a short duration of hearing loss. Cystic VS was significantly higher between the medium and large tumors, 24.3% and 38.1%. ( = 0.001), respectively. Patients with a short duration of hearing loss, balance disorders, EC located tumors, and cystic tumors have a significantly higher chance of a change in treatment strategy. Large tumor size at diagnosis and a cystic component were related to age > 65 years at diagnosis.
本研究旨在确定临床表现和肿瘤特征在前庭神经鞘瘤（VS）诊断时的作用，这些VS患者最初采用保守治疗。 本研究设计为回顾性病历审查。 该研究在国家三级VS患者转诊中心进行。 总共纳入了836例最初接受保守治疗的VS患者。 分析了患者特征：诊断时的年龄、性别、听力损失的频率和持续时间、耳鸣、平衡障碍（不稳、头晕和眩晕）；以及肿瘤特征：患侧、生长情况、囊性成分和位置，并与诊断时的肿瘤大小和治疗策略的变化相关联。 总共有169例（20%）患者的治疗策略发生了变化。诊断时对干预有高度影响的因素是听力损失持续时间短（风险比[HR]：4.8，<0.001）和囊性肿瘤（HR = 2.6，<0.001）。平衡障碍和外耳道外（EC）肿瘤位置对干预有中等影响（HR = 1.6，<0.01）。在干预组中，55%的患者出现肿瘤生长；我们发现其与听力损失持续时间短有显著相关性。中等大小和大肿瘤中的囊性VS分别显著更高，为24.
