Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st St Southwest, Rochester, MN 55905, USA; Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Drive, JBSA, TX 78234, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Otolaryngol Clin North Am. 2023 Jun;56(3):445-457. doi: 10.1016/j.otc.2023.02.006. Epub 2023 Apr 3.
The advent of MRI has led to more sporadic vestibular schwannomas diagnosed today than ever before. Despite the average patient being diagnosed in their sixth decade of life with a small tumor and minimal symptoms, population-based data demonstrate that more tumors per capita are treated today than ever before. Emerging natural history data justify either an upfront treatment approach or the "Size Threshold Surveillance" approach. Specifically, if the patient elects to pursue observation, then existing data support the tolerance of some growth during observation in appropriately selected patients up until a specific size threshold range (about 15 mm of CPA extension). The current article discusses the rationale behind a shift in the existing observation management approach, where initial detection of growth typically begets treatment, and outlines the application of a more flexible and nuanced approach based on existing evidence.
磁共振成像（MRI）的出现导致如今诊断出的前庭神经鞘瘤比以往任何时候都更加分散。尽管平均患者在 60 岁时被诊断出患有小肿瘤和轻微症状，但基于人群的数据表明，如今治疗的肿瘤比以往任何时候都多。新兴的自然病史数据证明，无论是采取积极的治疗方法还是“大小阈值监测”方法都是合理的。具体来说，如果患者选择观察，那么现有的数据支持在特定大小阈值范围内（约 15 毫米的 CPA 延伸），在适当选择的患者中，在观察期间容忍一些生长。本文讨论了现有观察管理方法转变背后的原理，其中最初的生长检测通常会引发治疗，并概述了基于现有证据的更灵活和细致入微的方法的应用。
