预后
如果用目前的技术治疗,患者会有非常好的预后及最少的并发症。40%至60%的小肿瘤可能不需要治疗。[4]Hoistad DL, Melnik G, Mamikoglu B, et al. Update on conservative management of acoustic neuroma. Otol Neurotol. 2001;22:682-685.http://www.ncbi.nlm.nih.gov/pubmed/11568679?tool=bestpractice.com[5]Beenstock M. Predicting the stability and growth of acoustic neuromas. Otol Neurotol. 2002;23:542-549.http://www.ncbi.nlm.nih.gov/pubmed/12170159?tool=bestpractice.com[6]Deen HG, Ebersold MJ, Harner SG, et al. Conservative management of acoustic neuroma: an outcome study. Neurosurgery. 1996;39:260-266.http://www.ncbi.nlm.nih.gov/pubmed/8832662?tool=bestpractice.com 用局灶放射外科进行治疗的肿瘤控制率可大于90%。[14]Lin VY, Stewart C, Grebenyuk J, et al. Unilateral acoustic neuromas: long-term hearing results in patients managed with fractionated stereotactic radiotherapy, hearing preservation surgery, and expectantly. Laryngoscope. 2005;115:292-296.http://www.ncbi.nlm.nih.gov/pubmed/15689753?tool=bestpractice.com[15]Pollock BE. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery. 2006;58:241-248.http://www.ncbi.nlm.nih.gov/pubmed/16462477?tool=bestpractice.com 对37项研究的荟萃分析发现,立体定向放射外科手术的整体疾病稳定率为91.1%(对显著发表偏性进行了调整)。[32]Pannullo SC, Fraser JF, Moliterno J, et al. Stereotactic radiosurgery: a meta-analysis of current therapeutic applications in neuro-oncologic disease. J Neurooncol. 2011;103:1-17.http://www.ncbi.nlm.nih.gov/pubmed/21152953?tool=bestpractice.com患者术后复发率小于5%。[33]Schmerber S, Palombi O, Boubagra K, et al. Long-term control of vestibular schwannoma after a translabyrinthine complete removal. Neurosurgery. 2005;57:693-698.http://www.ncbi.nlm.nih.gov/pubmed/16239881?tool=bestpractice.com[34]Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 1997;40:11-21.http://www.ncbi.nlm.nih.gov/pubmed/8971819?tool=bestpractice.com[35]Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery. 1995;36:215-224.http://www.ncbi.nlm.nih.gov/pubmed/7708162?tool=bestpractice.com 在有经验的治疗中心,无论治疗是观察、放疗还是手术,患者均有很好的(相当的)生活质量。[36]Akagami R, Di Maio S. Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas. J Neurosurg. 2009;111:855-862.http://www.ncbi.nlm.nih.gov/pubmed/19301957?tool=bestpractice.com
远期后遗症
如果术前基础听力接近正常,放射治疗可保留60%至80%的听力,手术治疗可保留高达80%的听力(取决于解剖部位,肿瘤大小和手术方法)。一项对49项研究进行的分析指出,手术的整体听力保留率为52%;颅中窝手术法比乙状窦后入路法有更好的听力保留效果。[37]Sughrue ME, Yang I, Aranda D, et al. Hearing preservation rates after microsurgical resection of vestibular schwannoma. J Clin Neurosci. 2010;17:1126-1129.http://www.ncbi.nlm.nih.gov/pubmed/20627586?tool=bestpractice.com放射治疗和手术的面神经保留率都很高。然而,结果高度依赖于肿瘤大小和医院的经验。[1]Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol. 1998;255:1-6.http://www.ncbi.nlm.nih.gov/pubmed/9592666?tool=bestpractice.com[17]Pollock BE, Lunsford LD, Noren G. Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery. 1998;43:475-483.http://www.ncbi.nlm.nih.gov/pubmed/9733302?tool=bestpractice.com[18]Barker FG II, Carter BS, Ojemann RG, et al. Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope. 2003;113:1332-1343.http://www.ncbi.nlm.nih.gov/pubmed/12897555?tool=bestpractice.com[19]Darrouzet V, Martel J, Enee V, et al. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 2004;114:681-688.http://www.ncbi.nlm.nih.gov/pubmed/15064624?tool=bestpractice.com[23]Roland JT Jr, Fishman AJ, Golfinos JG, et al. Cranial nerve preservation in surgery for large acoustic neuromas. Skull Base. 2004;14:85-91.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1151676/http://www.ncbi.nlm.nih.gov/pubmed/16145589?tool=bestpractice.com[38]Yong RL, Westerberg BD, Dong C, et al. Length of tumor-cochlear nerve contact and hearing outcome after surgery for vestibular schwannoma. J Neurosurg. 2008;108:105-110.http://www.ncbi.nlm.nih.gov/pubmed/18173318?tool=bestpractice.com 前庭雪旺细胞瘤治疗前和治疗后,前庭症状并不少见;这些症状的改善依赖于未受损伤的对侧前庭器官的补偿。[39]Passier L, Doherty D, Smith J, et al. Vestibular rehabilitation following the removal of an acoustic neuroma: a systematic review of randomized trials. Head Neck Oncol. 2012;4:59.http://www.ncbi.nlm.nih.gov/pubmed/23104541?tool=bestpractice.com[40]McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;(1):CD005397.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005397.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25581507?tool=bestpractice.com