Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study
Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study
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DOI：
10.3171/2017.8.jns171281
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发表时间：
2019-02-01
影响因子：
4.1
通讯作者：
Gatterbauer, Brigitte
中科院分区：
文献类型：
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作者：
Frischer, Josa M.;Gruber, Elise;Gatterbauer, Brigitte
目的：作者提供了接受伽玛刀放射外科（GKRS）治疗的听神经瘤患者的长期随访数据。方法：1992年至2016年，维也纳医科大学神经外科对618例听神经瘤患者进行了放射外科治疗。神经纤维瘤病患者和治疗时间太近而未获得1年随访的患者被排除在本回顾性研究之外。因此，提供了557例任何Koos分级的自发性听神经瘤患者的数据，以及426例至少随访2年的患者的长期随访数据。根据加德纳-罗伯逊（GR）听力量表和豪斯-Brackmann面神经功能量表，无论是之前GKRS和在随访times.Results四百五十二例（81%）进行了评估患者与放射外科治疗单独和105例（19%）与联合显微外科-放射外科。虽然联合治疗在2002年之前特别受欢迎，但自那时以来，单独使用放射外科治疗的病例比例显着增加。GKRS术后的总体并发症发生率较低，并且在过去十年中显著下降。GKRS后发生脑积水的风险随肿瘤大小而增加。GKRS术后恶变1例（0.2%）。无论Koos分级或治疗前，GKRS后5年、10年和15年的放射学肿瘤控制率分别为92%、91%和91%。不需要额外治疗的总体肿瘤控制率甚至更高，为98%。在最后一次随访时，在GKRS之前被分类为GR听力I级或II级的患者中，55%的功能性听力得以保留。GKRS术后5年、10年和15年的听力保留率分别为53%、34%和34%。多变量回归模型显示，GR听力类GKRS和耳蜗的中位剂量前的GR类在follow-up.CONCLUSIONS独立的预测因素在小型到中型的自发性听神经瘤，放射外科应被确认为主要的治疗在早期阶段。虽然最小化耳蜗剂量似乎有利于听力保护，但作者和以前的其他人一样，不建议对小管内肿瘤进行低剂量治疗。对于较大的听神经瘤，放射外科仍然是一种可靠的治疗选择，肿瘤控制率与较小的听神经瘤相似;但是，考虑到副作用的风险较高，建议谨慎选择患者并进行咨询。对于有明显脑干压迫或脑积水的听神经瘤必须考虑显微手术。
OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma.METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up.RESULTS Four hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up.CONCLUSIONS In small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.