Pollock B E, Lunsford L D, Kondziolka D, Flickinger J C, Bissonette D J, Kelsey S F, Jannetta P J
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania.
Neurosurgery. 1995 Jan;36(1):215-24; discussion 224-9. doi: 10.1227/00006123-199501000-00036.
Currently, microsurgical resection of acoustic neuromas by an experienced, multidisciplinary team is thought to be the treatment of choice. During the past 20 years stereotactic radiosurgery has been used as an alternative to surgical removal. To compare the results of both microsurgery and stereotactic radiosurgery, we conducted a study of 87 patients with unilateral, previously unoperated acoustic neuromas with an average diameter less than 3 cm treated by the neurosurgical service during 1990 and 1991. Preoperative patient characteristics and average tumor size were similar between the treatment groups. State of the art microsurgical or radiosurgical techniques were used by experienced surgeons in both treatment groups. The treatment groups were compared based on cranial nerve preservation, tumor control, postoperative complications, patient symptomatology, length of hospital stay, total management charges, effect on employment status, and overall patient satisfaction. Stereotactic radiosurgery was more effective in preserving normal postoperative facial function (P < 0.05), and hearing preservation (P < 0.03) with less treatment associated morbidity (P < 0.01). Effect on preoperative symptoms were similar between the treatment groups. Postoperative functional outcomes and patients' satisfaction of their tumor management were greater after stereotactic radiosurgery when compared to the microsurgical group, although they did not reach statistical significance (P = 0.07 and P = 0.10, respectively). Patients returned to independent functioning sooner after stereotactic radiosurgery (P < 0.001). Hospital length of stay and total management charges were less in the radiosurgical group (P < 0.001). When compared to microsurgical removal, stereotactic radiosurgery proved to be an effective and less costly management strategy of unilateral acoustic neuromas less than 3 cm in diameter. For many acoustic neuroma patients, stereotactic radiosurgery should be offered as an alternative management strategy.
目前，由经验丰富的多学科团队进行听神经瘤的显微手术切除被认为是首选治疗方法。在过去20年中，立体定向放射外科已被用作手术切除的替代方法。为比较显微手术和立体定向放射外科的治疗结果，我们对1990年和1991年期间神经外科治疗的87例单侧、未经手术的平均直径小于3 cm的听神经瘤患者进行了研究。治疗组之间术前患者特征和平均肿瘤大小相似。两个治疗组均由经验丰富的外科医生采用先进的显微手术或放射外科技术。基于颅神经保留、肿瘤控制、术后并发症、患者症状、住院时间、总治疗费用、对就业状况的影响以及患者总体满意度对治疗组进行比较。立体定向放射外科在保留术后正常面部功能（P<0.05）和听力保留（P<0.03）方面更有效，且治疗相关的发病率更低（P<0.01）。治疗组之间对术前症状的影响相似。与显微手术组相比，立体定向放射外科术后的功能结果和患者对肿瘤治疗的满意度更高，尽管未达到统计学意义（分别为P = 0.07和P = 0.10）。立体定向放射外科术后患者恢复独立功能更快（P<0.001）。放射外科组的住院时间和总治疗费用更低（P<0.001）。与显微手术切除相比，立体定向放射外科被证明是一种治疗直径小于3 cm的单侧听神经瘤的有效且成本更低的管理策略。对于许多听神经瘤患者，应提供立体定向放射外科作为一种替代管理策略。
