Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing.
Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing.
复制标题
伽玛刀治疗前庭神经鞘瘤患者保留可用听力后听力保留的相关因素。
DOI：
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复制
发表时间：
2011
影响因子：
4.1
通讯作者：
Takashi Yamamoto
中科院分区：
文献类型：
--
作者：
T. Hasegawa;Y. Kida;Takenori Kato;H. Iizuka;Takashi Yamamoto
对象
伽玛刀手术（GKS）是一种安全有效的治疗小到中型前庭神经鞘瘤（VS）的相对长期的结果。然而，即使使用最新的放射外科技术，GKS后的听力结果仍然不令人满意。本研究的目的是评估使用GKS治疗的VS和可用听力患者的听力保留率以及与听力保留相关的因素。
方法
在1991年至2009年期间接受GKS治疗的Gardner-Robertson（GR）I级或II级可用听力和VS患者中，117例可通过定期MR成像和听力测定进行评估。
结果
GKS发生时的中位年龄为52岁。4例患者（3%）既往接受过手术。GKS时，五十六例患者（48%）为GR I级听力，61例患者（52%）为GR II级听力。中位肿瘤体积为1.9 cm（3）。中位最大和肿瘤边缘辐射剂量分别为24和12戈伊。磁共振成像和听力测定的中位随访期分别为74个月和38个月。总肿瘤控制率为97.5%。3年、5年和8年的听力保留率分别为55%、43%和34%。多因素分析显示，GKS时GR听力等级和平均耳蜗剂量对听力保留有显著影响。在少数使用最新剂量计划技术治疗且治疗前具有GR I类听力的患者中，3年和5年听力保留率分别增加至80%和70%。
结论
对于大多数患有中小型VS的患者，GKS是切除术的有效且合理的替代方案，具有令人满意的长期肿瘤控制。与听力保护相关的因素包括GKS前GR I类听力和较低的平均耳蜗辐射剂量。为了保持可用的听力，重要的是在患者保持GR I类听力的同时应用GKS治疗。
OBJECT
Gamma Knife surgery (GKS) has been a safe and effective treatment for small- to medium-sized vestibular schwannomas (VSs) over relatively long-term outcomes. However, even with recent radiosurgical techniques, hearing results following GKS remain unsatisfactory. The purpose of this study was to evaluate the hearing preservation rate as well as factors related to hearing preservation in patients with VSs and serviceable hearing who were treated with GKS.
METHODS
Among patients with Gardner-Robertson (GR) Class I or II serviceable hearing and VSs treated with GKS between 1991 and 2009, 117 were evaluable via periodic MR imaging and audiometry.
RESULTS
The median age at the time of GKS was 52 years. Four patients (3%) had undergone prior surgery. Fifty-six patients (48%) had GR Class I hearing and 61 (52%) had GR Class II hearing at the time of GKS. The median tumor volume was 1.9 cm(3). The median maximum and tumor margin radiation doses were 24 and 12 Gy, respectively. The median follow-up periods for MR imaging and audiometry were 74 and 38 months, respectively. The overall tumor control rate was 97.5%. Actuarial 3-, 5-, and 8-year hearing preservation rates were 55%, 43%, and 34%, respectively. On multivariate analysis, GR hearing class at the time of GKS and the mean cochlear dose affected hearing preservation significantly. In a limited number of patients who were treated using the most recent dose planning techniques and who had GR Class I hearing before treatment, the 3- and 5-year hearing preservation rates increased to 80% and 70%, respectively.
CONCLUSIONS
For the majority of patients with small- to medium-sized VSs, GKS was an effective and reasonable alternative to resection with satisfactory long-term tumor control. Factors related to hearing preservation included a GR Class I hearing pre-GKS and a lower mean cochlear radiation dose. To retain serviceable hearing, it is important to apply GKS treatment while patients retain GR Class I hearing.
DOI：
10.1016/j.ijrobp.2004.08.019
发表时间：
2005-04-01
影响因子：
7
作者：
Pan, CC;Eisbruch, A;Kileny, PR
通讯作者：
Kileny, PR