Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up
Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up
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DOI：
10.1016/j.wneu.2018.03.175
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发表时间：
2018-06-01
影响因子：
2
通讯作者：
Regis, Jean
中科院分区：
文献类型：
--
作者：
Lefranc, Michel;Da Roz, Leila Maria;Regis, Jean
IV级前庭神经鞘瘤（Koos分类）通常被认为是显微外科切除或放射外科-显微外科联合手术的指征。然而，伽玛刀立体定向手术（GK-SRS）的位置，无论是作为一线治疗还是当残余肿瘤进展压迫脑干时，尚未得到明确的评估。本文报道了一组使用GK-SRS治疗4级前庭神经鞘瘤的大病例系列的结果。材料与方法：本研究纳入1996年至2011年间在我科连续接受gsk - srs治疗的所有IV级前庭神经鞘瘤患者，随访时间至少为3年。结果：86例患者接受GK-SRS治疗，至少随访3年。平均随访6.2年（3 ~ 16年）。GK-SRS时患者的平均年龄为54.6岁（范围：23-84），性别比为0.6。在放射手术时，没有患者在GK-SRS之前出现脑干功能障碍。38例患者治疗前有功能性听力。1例患者在GK-SRS前出现轻度三叉神经痛。78例（90.7%）患者获得肿瘤控制，无临床恶化。在这些患者中没有观察到辐射引起的脑干或脑神经毒性。25例患者保持功能性听力。8例（9.3%）患者出现肿瘤生长，7例需要显微手术切除，1例需要心室分流术。结论：基于这一大型系列研究，对于没有脑干功能障碍迹象的IV级前庭神经鞘瘤患者，GK-SRS似乎是一种安全有效的治疗选择。
INTRODUCTION: Grade IV vestibular schwannoma (Koos classification) is generally considered to be an indication for microsurgical resection or combined radiosurgery-microsurgery. However, the place of Gamma Knife stereotactic surgery (GK-SRS), either as first-line treatment or when progression of residual tumor compresses the brainstem, has not been clearly evaluated. This article reports the results of a large case series of patients with grade 4 vestibular schwannoma treated by GK-SRS.MATERIAL AND METHOD: All consecutive patients with grade IV vestibular schwannoma treated by GK-SRS in our department between 1996 and 2011 with a minimum follow-up of 3 years were included in this study.RESULTS: 86 patients were treated by GK-SRS with a minimum follow-up of 3 years. Mean follow-up was 6.2 years (3-16 years). The mean age of the patients at the time of GK-SRS was 54.6 years (range: 23-84) and the sex ratio was 0.6. At the time of radiosurgery, no patient presented brainstem dysfunction prior to GK-SRS. 38 patients had functional hearing before treatment. One patient presented mild trigeminal neuralgia before GK-SRS. Tumor control with no clinical deterioration was obtained in 78 patients (90.7%). No radiation-induced brainstem or cranial nerve toxicity was observed in any of these patients. Functional hearing was maintained in 25 patients. 8 (9.3%) patients presented tumor growth and required microsurgical resection in 7 cases and ventricular shunt in 1 case.CONCLUSION: On the basis of this large series, GK-SRS appears to be a safe and effective treatment option for grade IV vestibular schwannoma for patients with no signs of brainstem dysfunction.