Department of Skull Base Surgery, Cambridge University Hospitals.
Gonville & Caius College, Cambridge University.
Otol Neurotol. 2021 Jun 1;42(5):746-754. doi: 10.1097/MAO.0000000000003043.
Management of vestibular schwannomas (VS) involves surgery, radiotherapy, or surveillance, based on patient and tumor factors. We recently described conditional probability as a more accurate method for stratifying VS growth risk. Building on this, we now describe determinants of VS growth, allowing clinicians to move toward a more personalized approach to growth-risk profiling.
Retrospective analysis of a prospectively collected database in a tertiary referral skull base unit between 2005 and 2014. Inclusion of patients with unilateral VS managed on surveillance protocol for a minimum of 5 years. Analysis of patient age, sex, tumor location, tumor size, and symptomology using conditional probability.
A total of 340 patients met inclusion criteria. The conditional probability of growth of extracanalicular VS was significantly higher versus intracanalicular (IC) VS (30% versus 13%, p < 0.001) as was small-sized VS versus IC VS (28 versus 13%, p = 0.002), but only in the first year after diagnosis. Sex, age, and presenting symptoms did not significantly affect VS growth.
In our series, extracanalicular VS were more likely to grow than IC VS and small-sized VS more likely to grow than IC VS, but only in the first year after diagnosis. Conversely, sex, age, and presenting symptoms did not affect the conditional probability of VS growth.
听神经鞘瘤（VS）的治疗方法包括手术、放疗或随诊，这取决于患者和肿瘤因素。我们最近描述了条件概率是一种更准确的 VS 生长风险分层方法。在此基础上，我们现在描述了 VS 生长的决定因素，使临床医生能够朝着更个性化的生长风险分析方法发展。
对 2005 年至 2014 年期间在一个三级转诊颅底单位前瞻性收集的数据库进行回顾性分析。纳入单侧 VS 患者，这些患者采用随诊方案治疗至少 5 年。使用条件概率分析患者年龄、性别、肿瘤位置、肿瘤大小和症状。
共有 340 例患者符合纳入标准。与内听道内 VS（30%比 13%，p<0.001）相比，管外 VS 的生长概率明显更高，与内听道内 VS 相比，小体积 VS 的生长概率也更高（28%比 13%，p=0.002），但仅在诊断后第一年。性别、年龄和首发症状与 VS 生长无显著相关性。
在我们的系列研究中，与内听道内 VS 相比，管外 VS 更有可能生长，与内听道内 VS 相比，小体积 VS 更有可能生长，但仅在诊断后第一年。相反，性别、年龄和首发症状并不影响 VS 生长的条件概率。
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