Wang Sophie Shih-Yüng, van Eck Albertus, Naros Georgios, Horstmann Gerhard, Tatagiba Marcos
Department of Neurosurgery, University Hospital Tubingen, Eberhard Karls University, Tubingen, Germany.
Gamma Knife Center Krefeld, Krefeld, Germany.
Neurooncol Adv. 2025 Jan 29;7(1):vdaf021. doi: 10.1093/noajnl/vdaf021. eCollection 2025 Jan-Dec.
New-onset facial spasm (NOFS) has been reported to be a post-therapeutic side effect, when treating vestibular schwannoma (VS) with radiosurgery (SRS) and has been linked to post-treatment pseudoprogression. The aim of this study was to identify risk factors for developing NOFS after SRS treatment and to investigate NOFS as a clinical parameter for radiographic tumor response in VS.
This study included all consecutive patients of = 1,998 between 2004 and 2020, which were treated with SRS identified by a prospective registry. Patient and tumor characteristics (ie, sex, age, tumor extension and size, and intracanalicular extension) were analyzed retrospectively. Statistical testing was performed with R Studio.
The incidence of NOFS was 5% overall. In total, 62% were permanent NOFS, whereas 39% recovered spontaneously between 4 and 34 months, postinterventionally. The incidence of NOFS was unrelated to tumor volume-however, previous SRS increased the incidence of NOFS to 20%. In primary SRS therapy, facial spasm was associated with a higher recurrence rate compared to non-NOFS patients in the Kaplan-Meier analysis ( < 0.001). Tumor control decreased with increasing tumor size. The rate of pseudoprogression was higher in the group of transient NOFS at 39% compared to permanent NOFS at 18% ( = 0.032).
The risk of NOFS was significantly higher in recurrent compared to primary treatment (20% vs 5%) and the majority of NOFS was permanent. The incidence of permanent NOFS was significantly associated with treatment failure. Temporary NOFS was associated with pseudoprogression. Future analysis comparing the risk profile of either treatment option should include facial spasm as a significant VS-related postinterventional symptom. Patients with postinterventional NOFS should be followed-up long-term for higher risk of treatment failure.
据报道，在采用立体定向放射外科治疗（SRS）前庭神经鞘瘤（VS）时，新发面部痉挛（NOFS）是一种治疗后的副作用，并且与治疗后假性进展有关。本研究的目的是确定SRS治疗后发生NOFS的危险因素，并将NOFS作为VS影像学肿瘤反应的临床参数进行研究。
本研究纳入了2004年至2020年间通过前瞻性登记确定接受SRS治疗的1998例连续患者。回顾性分析患者和肿瘤特征（即性别、年龄、肿瘤扩展和大小以及内听道扩展）。使用R Studio进行统计检验。
NOFS的总体发生率为5%。总体而言，62%为永久性NOFS，而39%在干预后4至34个月内自发恢复。NOFS的发生率与肿瘤体积无关——然而，既往接受SRS会使NOFS的发生率增加至20%。在原发性SRS治疗中，在Kaplan-Meier分析中，与无NOFS的患者相比，面部痉挛与更高的复发率相关（P<0.001）。肿瘤控制率随肿瘤大小增加而降低。短暂性NOFS组的假性进展率为39%，高于永久性NOFS组的18%（P=0.032）。
与初次治疗相比，复发性治疗中NOFS的风险显著更高（20%对5%），并且大多数NOFS是永久性的。永久性NOFS的发生率与治疗失败显著相关。暂时性NOFS与假性进展相关。未来比较任何一种治疗方案风险特征的分析应将面部痉挛作为VS相关的重要干预后症状。干预后发生NOFS的患者应进行长期随访，因为其治疗失败风险更高。
