Long-Term Hearing Preservation Outcomes for Small Vestibular Schwannomas: Retrosigmoid Removal Versus Observation
Long-Term Hearing Preservation Outcomes for Small Vestibular Schwannomas: Retrosigmoid Removal Versus Observation
复制标题
小前庭神经鞘瘤的长期听力保护结果：乙状结肠后切除与观察
DOI：
10.1097/mao.0000000000001684
复制
发表时间：
2018-02-01
影响因子：
2.1
通讯作者：
Wu, Hao
中科院分区：
文献类型：
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作者：
Zhu, Weidong;Chen, Hongsai;Wu, Hao
目的：小前庭神经鞘瘤（VS）的治疗包括三种选择：连续观察，放射外科和显微外科手术。作者报告了110例乙状窦后肿瘤切除术后的长期听力结果和160例连续观察的小VSs患者的听力随访结果，以探讨小VSs听力保留的适当管理策略和预测因素。研究设计：回顾性研究。在这项研究中，110例小VS患者，2001年1月至2015年12月，15年期间（纯小管内/桥小脑角肿瘤15 mm），通过乙状窦后入路进行听力保留手术的候选人，160例患者作为连续观察的候选者。结果：110例患者术前听力A级49例，B级B 43例，C级18例。在所有手术患者（n=110）中，97.3%（107/110）的患者在术后随访期间保持相同水平（平均随访时间为49.128.2个月），86例（78.2%）至少随访4年有完整的放射学和听力测定数据可供审查。在4年随访手术组（n=86）中，22、11、18和35例患者的术后听力水平分别为A、B、C和D级，术后可用和有用听力的保留率分别为59.3%（51/86）和47.1%（33/70）。在连续观察组中，平均随访时间为35.2 ± 33.1个月，平均肿瘤大小为8.6 ± 4.3mm，总体平均肿瘤生长率为1.08 ± 2.3mm/年; 98例患者术后5年听力保留率为54.1%（53/98），7年听力保留率为48.7%（37/76）。肿瘤切除术应作为保留听力的小VSs患者的首选治疗方法，尤其是听力良好的年轻患者;乙状窦后入路是切除小VSs的有效、安全的入路，功能结局良好;术前听力越好，术后听力保留率越高;没有眼底延伸的患者比眼底延伸的患者更有可能实现听力保留，但在内窥镜辅助下进行乙状窦后切除时没有发现差异;与IVN起源的肿瘤相比，SVN起源的小肿瘤患者更有可能获得听力保留。
Objective: Management of small vestibular schwannomas (VSs) consists of three options: serial observation, radiosurgery, and microsurgery. The authors reported the long-term hearing outcomes after retrosigmoid tumor removal in 110 patients and hearing follow-up outcomes in 160 serial observation patients with small VSs to explore the appropriate management strategy and predictive factors of hearing preservation for small VSs.Study Design: Retrospective study.Setting: Tertiary referral center.Patients: In this study, 110 patients with small VS (purely intracanalicular/cerebellopontine angle tumor 15mm) during a 15-year period, from January 2001 to December 2015, were candidates for hearing preservation surgery through retrosigmoid approach, while 160 patients were candidates for serial observation. The main outcome measure was preservation of hearing under different hearing levels, assessed with the classification of American Academy of Otolaryngology-Head and Neck Surgery.Results: Preoperative hearing levels of the 110 study patients were Class A in 49 patients, Class B in 43 patients, and Class C in 18 patients. In all surgery patients (n=110), 97.3% (107/110) patients maintained the same level during postoperative follow-up (mean follow-up time was 49.128.2 mo) and 86 (78.2%) had complete radiologic and audiometric data at least 4 years follow-up for review. In the 4 years follow-up surgery group (n=86), postoperative hearing levels were Class A, B, C, and D for 22, 11, 18, and 35 patients, and postoperative rates of preservation of serviceable and useful hearing were 59.3% (51/86) and 47.1% (33/70), respectively. In serial observation group, mean follow-up time was 35.2 +/- 33.1 months; mean tumor size at presentation was 8.6 +/- 4.3mm; overall mean tumor growth rate was 1.08 +/- 2.3mm/yr; serviceable hearing preservation rate of 98 patients was 54.1% (53/98) at the 5-year end point and 48.7% (37/76) at the 7-year end point.Conclusion: Tumor removal should be the first treatment option for patients with small VSs and preserved hearing, especially for young patients with good hearing; retrosigmoid approach is an effective and safe approach for small VSs removal with excellent functional outcomes; better preoperative hearing predicted a higher rate of postoperative hearing preservation; patients without fundal extension were more likely to achieve hearing preservation than those with fundal extension, but no difference had been detected when retrosigmoid removal assisted with endoscope was performed; patients with small tumors originating from SVN were more likely to achieve hearing preservation compared with those with IVN-originating tumors.