Fík Zdeněk, Vlasák Aleš, Zvěřina Eduard, Sýba Jaroslav, Lazák Jan, Peterková Lenka, Koucký Vladimír, Betka Jan
Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic.
Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic.
Biomedicines. 2023 Jan 25;11(2):340. doi: 10.3390/biomedicines11020340.
The incidence of sporadic vestibular schwannoma has significantly increased over the past few decades. However, there is no method currently available to accurately predict the risk of subsequent tumor growth. The difference in the management of five patient groups has been evaluated: wait and scan, conversion to microsurgery, conversion to stereoradiotherapy, sterioradiotherapy, and microsurgery. In total, 463 patients with vestibular schwannoma have been consulted in our department from 2010 through 2016. Of the 250 patients initially indicated for observation, 32.4% were later indicated for active treatment. Younger patients were more frequently indicated for surgery (mean age 48 years) compared to older patients, who were more often indicated for stereoradiotherapy (mean age 62 years). Tumor growth was observed more often in patients under 60 years of age and in patients with tumors greater than 10 mm. In elderly patients, including those with larger tumors, a conservative approach is the optimal solution. If tumor growth occurs in the wait-and-scan strategy, it is still possible to continue with a conservative approach in some situations. The duration of follow-up scans is still a matter of debate, as tumors can begin to grow after 5 years from the initial diagnosis.
在过去几十年中，散发性前庭神经鞘瘤的发病率显著上升。然而，目前尚无方法能够准确预测后续肿瘤生长的风险。研究评估了五组患者的治疗差异：观察等待、转为显微手术、转为立体定向放射治疗、立体定向放射治疗以及显微手术。2010年至2016年期间，我院共诊治了463例前庭神经鞘瘤患者。在最初建议观察的250例患者中，32.4%后来需要积极治疗。与年龄较大的患者（平均年龄62岁，更常接受立体定向放射治疗）相比，年轻患者（平均年龄48岁）更常接受手术治疗。60岁以下患者以及肿瘤大于10mm的患者中，肿瘤生长更为常见。对于老年患者，包括肿瘤较大的患者，保守治疗是最佳方案。如果在观察等待策略中出现肿瘤生长，在某些情况下仍可继续采用保守治疗。随访扫描的时长仍存在争议，因为肿瘤可能在初次诊断5年后开始生长。
