Intracapsular decompression or radical resection followed by Gamma Knife surgery for patients harboring a large vestibular schwannoma Clinical article
Intracapsular decompression or radical resection followed by Gamma Knife surgery for patients harboring a large vestibular schwannoma Clinical article
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DOI：
10.3171/2012.6.gks12697
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发表时间：
2012-12-01
影响因子：
4.1
通讯作者：
Yang, Dar-Yu
中科院分区：
文献类型：
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作者：
Pan, Hung-Chuan;Sheehan, Jason;Yang, Dar-Yu
对象。显微手术是前庭神经鞘瘤（VS）患者的主要治疗方法。然而，其结果可能导致听力损伤和面神经功能障碍，特别是当切除延伸到肿瘤囊外时。当手术包括囊内切除和减压时，可以更好地保留面部和听力功能。在这项研究中，作者比较了囊内减压后伽玛刀手术（GKS）与标准显微手术后放射手术的结果。在2003年8月至2008年10月期间，35名患有大室间隔（直径为30cm）的患者被纳入本研究。18例患者行囊内减压后行GKS （I组），17例患者行根治性囊外切除术后行GKS （II组）。在所有病例中，GKS均以12 Gy的边际剂量进行。所有患者均随访至少3年。所有患者还接受了定期听力学、神经电图（ENoG）、MR成像和SF-36表格测试。采用学生t检验和重复方差分析进行统计分析。I组和II组患者的平均年龄（+/- SEM）分别为50 +/- 3.0岁和49 +/- 2.3岁。实验组男女比例分别为8:10和7:10。术前根据House-Brackmann面部评分系统（I级或11级），所有患者面部功能均良好。术后，ⅰ组16例（89%）患者面部功能良好，ⅱ组6例（35%）患者面部功能良好（p < 0.01）。第一组11例患者听力正常，术后11例（100%）均保留听力功能。II组11例患者术后听力正常，无一例患者术后听力功能保留（p < 0.001）。I组平均肿瘤体积（+/- SEM）为17.5 +/- 1.1 cm(3)，术后体积为9.35 +/- 1.02 cm(3)。II组平均肿瘤体积为16.4±0.95 cm(3)，术后肿瘤体积为1.1±0.14 cm(3) （p < 0.001）。GKS后，I组和II组的肿瘤体积分别减少到5.12 +/- 1.1 cm(3)和0.9 +/- 0.1 cm(3)。GKS后无患者出现不良反应。土地ⅱ组的平均恢复工作时间分别为2.4 +/- 0.16周和33.4 +/- 4.3周（p < 0.001）。根据36项简短健康调查（SF-36）的结果，I组患者的生活质量比II组患者有更显著的改善（p < 0.001）。与根治性囊外切除术后GKS相比，囊内减压后GKS提供了更好的神经预后和生活质量。该方法在较大室性血管瘤患者中的进一步应用似乎是合理的。(http://thejns.org/doi/abs/10.3171/2012.6.GKS12697)
Object. Microsurgery is the primary treatment used for patients harboring a large vestibular schwannoma (VS). However, its outcome may lead to hearing impairment and facial nerve dysfunction particularly when resection is extended outside the tumor capsule. When surgery for a large VS consists of intracapsular resection and decompression, better preservation of facial and hearing function are obtained. In this study, the authors compared outcomes of intracapsular decompression followed by Gamma Knife surgery (GKS) with outcomes of standard microsurgery followed by radiosurgery.Methods. Between August 2003 and October 2008, 35 patients harboring large VSs (> 3 cm in diameter) were enrolled in this study. Eighteen patients underwent intracapsular decompression followed by GKS (Group I), and 17 patients underwent radical extracapsular resection followed by GKS (Group II). In all cases GKS was performed with a margin dose of 12 Gy. All patients were followed up for at least 3 years. All patients also underwent periodic audiography, electroneuronography (ENoG), MR imaging, and testing with the SF-36 form. The Student t-test and repeated ANOVA were used for statistical analysis.Results. The mean ages of the patients (+/- SEM) in Groups I and II were 50 +/- 3.0 and 49 +/- 2.3 years, respectively. The female/male ratios were 8:10 in Group I and 7:10 in Group II. All patients had excellent facial function as measured according to the House-Brackmann Facial Grading System (Grade I or 11) preoperatively. After the operation, 16 patients (89%) in Group I retained excellent facial function, whereas only 6 patients (35%) in Group II had excellent facial function (p < 0.01). In Group I, 11 patients had serviceable hearing, and all 11(100%) retained hearing function after the operation. In Group II, 11 patients had serviceable hearing, but none retained hearing function postoperatively (p < 0.001). In Group I, the mean tumor volume (+/- SEM) was 17.5 +/- 1.1 cm(3), and the postoperative volume was 9.35 +/- 1.02 cm(3). In Group II, the mean tumor volume was 16.4 +/- 0.95 cm(3), whereas the postoperative volume was 1.1 +/- 0.14 cm(3) (p < 0.001). After GKS, the tumor volume was reduced to 5.12 +/- 1.1 cm(3) and 0.9 +/- 0.1 cm(3) in Groups I and II, respectively. No patients experienced adverse effects after GKS. The mean return-to-work times were 2.4 +/- 0.16 and 33.4 +/- 4.3 weeks in Groups land II, respectively (p < 0.001). According to the results obtained using the 36-Item Short Form Health Survey (SF-36), patients in Group I enjoyed more significant improvements in quality of life than patients in Group II (p < 0.001).Conclusions. Intracapsular decompression followed by GKS afforded a better neurological outcome and quality of life than radical extracapsular resection followed by GKS. Further application of this approach in patients harboring large VSs seems warranted. (http://thejns.org/doi/abs/10.3171/2012.6.GKS12697)