Department of Otorhinolaryngology-Head and Neck Surgery.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Otol Neurotol. 2020 Dec;41(10):e1304-e1313. doi: 10.1097/MAO.0000000000002887.
To assess vestibular schwannoma (VS) practice patterns among providers.
Cross-sectional survey.
8th Quadrennial International Conference on Vestibular Schwannoma and Other CPA Tumors.
Clinicians who specialize in the management of VS.
Responses to questions on the management and anticipated outcomes of VS for a series of common clinical scenarios were compared by specialty (otolaryngology versus neurosurgery), level of experience, scope of practice (surgery versus radiation and surgery), and geographic location of practice (United States versus international).
Responses from 110 participants were analyzed. Overall, 53% of respondents were otolaryngologists, 60% had greater than 10 years of experience, and 57% practiced within the United States. In total, 86% of respondents would pursue initial observation for themselves if diagnosed with a 4 mm distal intracanalicular VS; however, practicing radiosurgeons were more likely to select stereotactic radiosurgery for this scenario compared with providers who solely practice surgery (14 versus 0%; p = 0.032). Otolaryngologists and neurosurgeons alike report that radiosurgery should not be considered a long-term hearing preservation strategy.Otolaryngologists were more optimistic regarding microsurgical hearing preservation outcomes for small distal intracanalicular tumors compared with neurosurgeons (11 versus 3% selected a high likelihood of maintaining class A/B hearing; p = 0.007). Ninety-five percent of respondents prioritized facial nerve outcome over complete disease removal in the context of microsurgical resection of large tumors.
Management decision-making and expected outcomes for various clinical scenarios were largely similar among providers; however, variances in several key clinical areas exist. This study points to the feasibility of developing a widely accepted consensus statement among VS experts across specialties.
评估前庭神经鞘瘤（VS）治疗方案在医疗服务提供者中的应用。
横断面调查。
第八届国际前庭神经鞘瘤和其他 CPA 肿瘤会议。
专门从事 VS 管理的临床医生。
根据专业（耳鼻喉科与神经外科）、经验水平、实践范围（手术与放射治疗和手术）以及实践地理位置（美国与国际），比较参与者对一系列常见临床情况的 VS 管理和预期结果的回答。
分析了 110 名参与者的回复。总体而言，53%的参与者为耳鼻喉科医生，60%的参与者经验超过 10 年，57%的参与者在美国境内执业。总共，86%的参与者如果被诊断为 4 毫米远段内听道 VS，会选择进行初始观察；然而，与仅行手术的医疗服务提供者相比，行放射治疗的医疗服务提供者更倾向于选择立体定向放射治疗（14 比 0%；p=0.032）。耳鼻喉科医生和神经外科医生都认为放射治疗不应作为长期听力保护策略。耳鼻喉科医生对小远段内听道肿瘤的显微外科听力保护结果更为乐观，与神经外科医生相比（11 比 3%选择高几率保留 A/B 级听力；p=0.007）。95%的参与者在大型肿瘤的显微外科切除中，优先考虑面神经结果而非完全清除疾病。
在各种临床情况下，不同医疗服务提供者的管理决策和预期结果基本相似；然而，在一些关键临床领域存在差异。本研究表明，在各专业的 VS 专家之间制定广泛接受的共识声明是可行的。
