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首页> 外文期刊>Neurosurgery >Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.
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Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.

机译：处理前庭神经鞘瘤后的患者预后：显微手术切除与立体定向放射外科的前瞻性比较。

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OBJECTIVE: The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. METHODS:: A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). RESULTS: Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). CONCLUSION: Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.
机译：目的：对中小型前庭神经鞘瘤（VS）患者的最佳治疗尚存争议。方法：一项前瞻性队列研究对82例单侧，未手术VS小于3 cm的患者进行了手术切除（n = 36）或放射外科手术（n = 46）。接受切除术的患者年龄较小（48.2岁对53.9岁，P = 0.03）。两组在听力下降，相关症状和肿瘤大小方面相似。平均随访期为42个月（范围：12-62个月）。结果：与手术组相比，放疗组在三个月（P <0.001），一年（P <0.001）和最后一次随访检查（P <0.01）时，正常的面部运动和可保留的听力更为频繁。手术切除组。手术后3个月，接受手术切除的患者在以下健康状况问卷的以下子维度上有显着下降：身体机能（P = 0.006），角色-身体（P <0.001），能量/疲劳（P = 0.02）和总体物理成分（P = 0.004）。手术切除组的患者在1年时的身体机能（P = 0.04）和身体疼痛（P = 0.04）分量表继续显着下降，而在上一次随访检查中，身体疼痛（P = 0.02）显着下降。手术后，放射外科组的健康状况调查表的任何组成部分均未下降。在最后一次随访检查中，放射外科组的头昏障碍清单平均得分较低（分别为16.5和8.4，P = 0.02）。肿瘤对照无差异（100％对96％，P = 0.50）。结论：接受立体定向放射手术的VS患者的早期结局优于手术切除（2级证据）。除非长期随访评估显示在当前使用的放射剂量下肿瘤频繁进展，否则对于大多数VS患者，放射外科应被视为最佳治疗策略。

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