Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
BMJ Case Rep. 2021 May 27;14(5):e241834. doi: 10.1136/bcr-2021-241834.
A 25-year-old man presented with left-sided hearing loss, blurred vision and papilloedema. Imaging revealed a large, left-sided, contrast-enhancing cerebellopontine mass causing obstructive hydrocephalus, consistent with vestibular schwannoma (VS). Following an incomplete resection via retrosigmoid craniotomy at an outside facility, he was referred to our department, and cerebrospinal fluid diversion followed by repeat resection was recommended. A subtotal resection was achieved, and the patient was subsequently treated with adjuvant stereotactic radiosurgery (SRS). Progressive interval growth was observed on serial post-SRS MRI studies; correspondingly, at 31 months after treatment, the patient was initiated on antiprogrammed-death receptor 1 (PD-1) antibody treatment with pembrolizumab. Growth arrest was noted on subsequent serial imaging studies, which have been maintained for a total of 30 months since initiation of a 18-month anti-PD-1 course of therapy. Additional case accumulation and translational study is required to better characterise this therapeutic strategy; however, PD-1/programmed death-ligand 1 inhibition may offer a promising salvage therapy for refractory VS.
一位 25 岁男性患者因左侧听力丧失、视力模糊和视乳头水肿就诊。影像学检查显示左侧桥小脑角区有一个大的、对比增强的肿块，导致梗阻性脑积水，符合前庭神经鞘瘤（VS）的表现。在一家外院接受了经乙状窦后颅窝入路的不完全切除术，他被转到我们科室，建议进行脑脊液分流和再次切除。实现了次全切除，随后对患者进行了辅助立体定向放射外科治疗（SRS）。在一系列 SRS 后 MRI 研究中观察到肿瘤逐渐增大；因此，在治疗后 31 个月，开始使用派姆单抗进行抗程序性死亡受体 1（PD-1）抗体治疗。在后续的连续影像学研究中观察到肿瘤生长停止，自开始 18 个月的抗 PD-1 治疗以来，已维持了 30 个月。需要进一步积累病例并进行转化研究以更好地描述这种治疗策略；然而，PD-1/程序性死亡配体 1 抑制可能为复发性 VS 提供一种有前途的挽救治疗方法。
