Kondziolka D, Lunsford L D, McLaughlin M R, Flickinger J C
Department of Neurological Surgery, University of Pittsburgh, PA 15213, USA.
N Engl J Med. 1998 Nov 12;339(20):1426-33. doi: 10.1056/NEJM199811123392003.
Stereotactic radiosurgery is the principal alternative to microsurgical resection for acoustic neuromas (vestibular schwannomas). The goals of radiosurgery are the long-term prevention of tumor growth, maintenance of neurologic function, and prevention of new neurologic deficits. Although acceptable short-term outcomes have been reported, long-term outcomes have not been well documented.
We evaluated 162 consecutive patients who underwent radiosurgery for acoustic neuromas between 1987 and 1992 by means of serial imaging tests, clinical evaluations, and a survey between 5 and 10 years after the procedure. The average dose of radiation to the tumor margin was 16 Gy, and the mean transverse diameter of the tumor was 22 mm (range, 8 to 39). Resection had been performed previously in 42 patients (26 percent); in 13 patients the tumor represented a recurrence of disease after a previous total resection. Facial function was normal in 76 percent of the patients before radiosurgery, and 20 percent had useful hearing.
The rate of tumor control (with no resection required) was 98 percent. One hundred tumors (62 percent) became smaller, 53 (33 percent) remained unchanged in size, and 9 (6 percent) became slightly larger. Resection was performed in four patients (2 percent) within four years after radiosurgery. Normal facial function was preserved in 79 percent of the patients after five years (House-Brackmann grade 1), and normal trigeminal function was preserved in 73 percent. Fifty-one percent of the patients had no change in hearing ability. No new neurologic deficits appeared more than 28 months after radiosurgery. An outcomes questionnaire was returned by 115 patients (77 percent of the 149 patients still living). Fifty-four of these patients (47 percent) were employed at the time of radiosurgery, and 37 (69 percent) remained so. Radiosurgery was believed to have been successful by all 30 patients who had undergone surgery previously and by 81 (95 percent) of the 85 who had not. Thirty-six of the 115 patients (31 percent) described at least one complication, which resolved in 56 percent of those cases.
Radiosurgery can provide long-term control of acoustic neuromas while preserving neurologic function.
立体定向放射外科是听神经瘤（前庭神经鞘瘤）显微手术切除的主要替代方法。放射外科的目标是长期预防肿瘤生长、维持神经功能以及预防新的神经功能缺损。尽管已有关于短期可接受结果的报道，但长期结果尚未得到充分记录。
我们评估了1987年至1992年间连续接受听神经瘤放射外科治疗的162例患者，通过系列影像学检查、临床评估以及术后5至10年的一项调查。肿瘤边缘的平均辐射剂量为16 Gy，肿瘤的平均横径为22 mm（范围8至39 mm）。42例患者（26%）先前已接受过切除术；13例患者的肿瘤是先前全切除术后疾病的复发。放射外科治疗前76%的患者面部功能正常，20%的患者有有用听力。
肿瘤控制率（无需切除）为98%。100个肿瘤（62%）变小，53个（33%）大小不变，9个（6%）略有增大。4例患者（2%）在放射外科治疗后4年内接受了切除术。5年后79%的患者保留了正常面部功能（House-Brackmann 1级），73%的患者保留了正常三叉神经功能。51%的患者听力能力无变化。放射外科治疗后28个月内未出现新的神经功能缺损。115例患者（仍在世的149例患者中的77%）返回了一份结果调查问卷。这些患者中有54例（47%）在接受放射外科治疗时已就业，37例（69%）仍在就业。所有30例先前接受过手术的患者以及85例未接受过手术患者中的81例（95%）认为放射外科治疗是成功的。115例患者中有36例（31%）描述了至少一种并发症，其中56%的病例并发症得到缓解。
放射外科可以在保留神经功能的同时实现听神经瘤的长期控制。
