Matthies C, Samii M
Department of Neurosurgery, Nordstadt Hospital, Hannover, Germany.
Neurosurgery. 1997 Jan;40(1):1-9; discussion 9-10. doi: 10.1097/00006123-199701000-00001.
Despite good knowledge of the key symptoms of vestibular schwannomas and their significance for surgical results, the evolution of symptoms and signs and their relation to tumor extension still need thorough investigation.
From 1978 to 1993, operations were performed by the same surgeon (M.S.) on 1000 vestibular schwannomas at the Neurosurgical Department of Nordstadt Hospital. The vestibular schwannomas were diagnosed in 962 patients, including 522 female patients (54%) and 440 male patients (46%); the mean age was significantly higher in female patients (47.6 yr) than in men (45.2 yr). We focused our analysis on the incidence of subjective disturbances versus objective morbidity, on the sequence of symptom onset, and on symptom duration and symptomatology versus tumor size and extension.
The most frequent clinical symptoms were disturbances of the acoustic (95%), vestibular (61%), trigeminal (9%), and facial (6%) nerves. Symptom duration was 3.7 years for hearing loss, 1.9 years for facial paresis, and 1.3 years for trigeminal disturbances. Symptom incidence and duration did not strictly correlate with tumor size. Key symptoms of various tumor extension classes precipitated the diagnosis, such as trigeminal disturbances in large tumors with brain stem compression or tinnitus in small neuromas. In cases of trigeminal or facial nerve symptoms, the overall duration of symptomatology was much shorter. According to the subjective perception of the patients, between only one- and two-thirds of nerve disturbances were noticed. Patients with preoperative deafness had become deaf either chronically (23%) or suddenly (3%); even in cases of moderate hearing deficit that lasts a long time, deafness can occur suddenly. The rate of tinnitus was higher in hearing than in deaf patients; however, deafness does not mean relief from tinnitus, because this symptom persists in 46% of preoperatively deaf patients. Vestibular disturbances most often occur as some unsteadiness while walking or as vertigo, and the symptoms frequently are fluctuating, not constant.
Differences in tumor biology can be underestimated and are not visible on radiological scans. For example, intrameatal tumors, despite their small size, present with a duration of symptoms that is representative of the larger tumors and are most frequently associated with vestibular symptoms and with tinnitus. Large tumors with brain stem compression present with relatively shorter symptom durations and at a younger age; both factors are suggestive of especially fast tumor growth. The clinical findings presented in this study promote new consideration of the dynamics of tumor growth and of the affected neural tissues.
尽管对前庭神经鞘瘤的关键症状及其对手术结果的意义有充分了解，但症状和体征的演变及其与肿瘤扩展的关系仍需深入研究。
1978年至1993年，同一位外科医生（M.S.）在北stadt医院神经外科对1000例前庭神经鞘瘤进行了手术。962例患者被诊断为前庭神经鞘瘤，其中女性患者522例（54%），男性患者440例（46%）；女性患者的平均年龄（47.6岁）显著高于男性患者（45.2岁）。我们的分析重点在于主观障碍与客观发病率的发生率、症状出现的顺序、症状持续时间以及症状与肿瘤大小和扩展的关系。
最常见的临床症状是听神经（95%）、前庭神经（61%）、三叉神经（9%）和面神经（6%）的功能障碍。听力丧失的症状持续时间为3.7年，面部麻痹为1.9年，三叉神经功能障碍为1.3年。症状发生率和持续时间与肿瘤大小并不严格相关。不同肿瘤扩展类别的关键症状促成了诊断，例如脑干受压的大型肿瘤中的三叉神经功能障碍或小型神经瘤中的耳鸣。在出现三叉神经或面神经症状的情况下，症状的总体持续时间要短得多。根据患者的主观感受，仅发现了三分之一至三分之二的神经功能障碍。术前耳聋的患者要么是慢性耳聋（23%），要么是突然耳聋（3%）；即使在中度听力缺陷持续很长时间的情况下，也可能突然发生耳聋。耳鸣在听力正常的患者中的发生率高于耳聋患者；然而，耳聋并不意味着耳鸣缓解，因为46%的术前耳聋患者仍有此症状。前庭功能障碍最常表现为行走时的不稳或眩晕，症状通常波动，而非持续存在。
肿瘤生物学差异可能被低估，且在放射学扫描中不可见。例如，内耳道内的肿瘤尽管体积小，但症状持续时间却代表了较大肿瘤的特征，且最常与前庭症状和耳鸣相关。脑干受压的大型肿瘤症状持续时间相对较短，且发病年龄较轻；这两个因素都提示肿瘤生长特别迅速。本研究中的临床发现促使人们对肿瘤生长动力学和受影响神经组织进行新的思考。
