Turek Grzegorz, Dzierzęcki Sebastian, Obierzyński Paweł, Drożdż Adrian, Mariak Zenon, Zielińska-Turek Justyna, Czyżewski Wojciech, Dżaman Karolina, Ząbek Mirosław
Department of Neurosurgery, Bródnowski Masovian Hospital, 03-242 Warsaw, Poland.
Gamma Knife Centre, 03-242 Warsaw, Poland.
J Clin Med. 2024 Jul 14;13(14):4107. doi: 10.3390/jcm13144107.
: Surgical resection of medium to large vestibular schwannomas (VSs, Koos grade 3 and 4) is a widely used approach, although stereotactic radiosurgery (SRS) is increasingly proposed as initial treatment. The quality of life-centered approach is challenged in cases where tumor growth control cannot be achieved with SRS, thus necessitating salvage surgery. We present a series of eight consecutive patients who required surgery due to continued tumor growth after SRS. : Of the 146 patients with VS grades 3 and 4 initially treated with SRS, only eight patients (mean age, 54 ± 7.2 years; range, 42-63 years) required subsequent surgery. Their mean tumor volume was 9.9 ± 3.2 cm. The mean time from SRS to first tumor progression and planned subtotal resection was 23 ± 5.9 months and 45 ± 17.5 months, respectively. SRS was not performed after the surgery in favor of a "wait and rescan" approach. Tumor residue was monitored on follow-up magnetic resonance imaging. In all patients, tumor growth control after planned subtotal resection was maintained at 63 ± 19.8 months. None of the 146 patients had serious complications after SRS. In the eight patients who required surgery, tumor growth between 22% and 212% (mean, 4 cm) was reported within 26 to 84 months after SRS. Before salvage surgery, they scored 1 point on the House-Brackmann scale. Subtotal excision was performed, and VIIth nerve function was preserved in all patients. At 63 ± 19.8 months, 3 patients had a House-Brackmann score of 1, four patients had a score of 2, and one patient had a score of 3. Surgical excision of medium to large VS after SRS can be relatively safe, provided that a quality of life-centered approach of subtotal resection is used.
手术切除中大型前庭神经鞘瘤（VSs，库斯3级和4级）是一种广泛应用的方法，尽管立体定向放射外科（SRS）越来越多地被提议作为初始治疗方法。在SRS无法实现肿瘤生长控制的情况下，以生活质量为中心的方法受到挑战，因此需要挽救性手术。我们报告了一系列连续8例患者，他们在SRS后因肿瘤持续生长而需要手术。在最初接受SRS治疗的146例3级和4级VS患者中，只有8例患者（平均年龄54±7.2岁；范围42 - 63岁）需要后续手术。他们的平均肿瘤体积为9.9±3.2 cm³。从SRS到首次肿瘤进展和计划次全切除的平均时间分别为23±5.9个月和45±17.5个月。手术后未进行SRS，而是采用“等待并重新扫描”的方法。通过随访磁共振成像监测肿瘤残留情况。在所有患者中，计划次全切除后肿瘤生长控制维持了63±19.8个月。146例患者在SRS后均无严重并发症。在8例需要手术的患者中，SRS后26至84个月内报告肿瘤生长22%至212%（平均4 cm³）。在挽救性手术前，他们在House - Brackmann量表上得分为1分。进行了次全切除，所有患者的面神经功能均得以保留。在63±19.8个月时，3例患者的House - Brackmann评分为1分，4例患者评分为2分，1例患者评分为3分。如果采用以生活质量为中心的次全切除方法，SRS后对中大型VS进行手术切除可能相对安全。
