Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Acta Neurochir (Wien). 2022 Sep;164(9):2473-2481. doi: 10.1007/s00701-022-05187-w. Epub 2022 Mar 26.
Surgical removal has been performed as the first line treatment for symptomatic or enlarging hypoglossal schwannomas (HS). Stereotactic radiosurgery (SRS) offers a minimally invasive approach that may afford long-term tumor control for patients with HS particularly those who refuse or are unfit for surgery. This study evaluates outcomes after SRS performed for both newly diagnosed and residual tumors after incomplete resection.
This retrospective, multi-institutional study involved patients treated with adjuvant or primary SRS for HS. The study end-points included local tumor response, clinical outcomes, and procedure-related complications. All the patients had Gamma Knife SRS.
The cohort included 12 patients (five females), median age at SRS 49.5 years (range, 37-76)]. The median tumor target volume was 5.9 cm (range, 0.7-27.23). At median imaging follow-up of 37 months (range, 6-153), tumor control was achieved in 11 patients. Tumor enlargement that was managed with surgical resection was noted at the 6-month follow-up in one patient. At median clinical follow-up of 30.5 months (range, 6-157), stability, or improvement of all pre-SRS signs and symptoms was noted in nine patients. Two patients experienced worsening of at least one pre-existing symptoms or sign. New-onset trapezius weakness was noted in one patient and tongue atrophy in two patients.
Single-fraction SRS appears to be a safe and effective upfront and adjuvant treatment option for HS. SRS may be recommended as an alternative to surgery for patients presenting with HS or as an adjuvant treatment following subtotal resection and at HS recurrence.
对于有症状或增大的舌下神经鞘瘤（HS），手术切除已作为一线治疗方法。立体定向放射外科（SRS）提供了一种微创方法，可为 HS 患者，尤其是拒绝或不适合手术的患者，提供长期的肿瘤控制。本研究评估了 SRS 治疗新诊断和不完全切除后残留肿瘤的结果。
这是一项回顾性的多中心研究，纳入了接受 SRS 辅助或原发性治疗 HS 的患者。研究终点包括局部肿瘤反应、临床结果和与手术相关的并发症。所有患者均接受伽玛刀 SRS 治疗。
该队列包括 12 名患者（5 名女性），SRS 时的中位年龄为 49.5 岁（范围，37-76 岁）。中位肿瘤靶体积为 5.9cm（范围，0.7-27.23）。在中位影像学随访 37 个月（范围，6-153 个月）时，11 名患者实现了肿瘤控制。一名患者在 6 个月随访时发现肿瘤增大，需要手术切除。在中位临床随访 30.5 个月（范围，6-157 个月）时，9 名患者的所有术前症状和体征稳定或改善。两名患者至少有一种原有症状或体征恶化。一名患者出现新发性斜方肌无力，两名患者出现舌萎缩。
单次分割 SRS 似乎是 HS 的一种安全有效的一线和辅助治疗选择。SRS 可作为手术治疗 HS 或作为不完全切除后辅助治疗和 HS 复发后的替代方法。
