精准医学时代的听神经瘤：分子见解、影像生物标志物及不断演变的管理策略的最新叙述性综述。

文献信息

中文摘要

听神经瘤（VS）的诊疗日益受到分子和影像学进展的影响，这些进展补充了传统的基于大小和症状的决策。近期的多组学研究，包括单细胞和空间转录组学以及甲基化谱分析，揭示了生物学上不同的施万细胞状态和微环境程序，可能有助于解释异质性生长、听力下降和治疗反应。与此同时，定量磁共振成像、放射组学和早期放射基因组学努力正朝着标准化、符合影像生物标志物标准化倡议的流程和自动分割方向发展，从而实现更可重复的风险模型。在临床上，前瞻性比较证据（例如，听神经瘤：放射外科或期待治疗以及听神经瘤国际主动监测研究）已完善了中小型肿瘤观察与 upfront 放射外科的争论，而当代规划强调保留耳蜗以最大化听力保留。靶向全身治疗主要仍与NF2相关疾病有关，贝伐珠单抗作为概念验证，多种通路导向药物正在评估中。本叙述性综述综合了这些进展，并概述了一个实用框架，将生物学和影像生物标志物整合到个体化监测和治疗选择中，同时强调了局限性和多中心验证的优先事项。

英文摘要

Vestibular schwannoma (VS) care is increasingly shaped by molecular and imaging advances that complement conventional size- and symptom-based decision-making. Recent multi-omic studies, including single-cell and spatial transcriptomics and methylation profiling, reveal biologically distinct Schwann cell states and microenvironmental programs that may help explain heterogeneous growth, hearing decline, and treatment response. In parallel, quantitative magnetic resonance imaging, radiomics, and early radiogenomic efforts are moving toward standardized, Image Biomarker Standardisation Initiative-compliant pipelines and automated segmentation, enabling more reproducible risk models. Clinically, prospective comparative evidence (e.g., Vestibular schwannoma: Radiosurgery or Expectation and Vestibular Schwannoma International Study of Active Surveillance has refined the observation vs. upfront radiosurgery debate for small-to-medium tumors, while contemporary planning emphasizes cochlear sparing to maximize hearing preservation. Targeted systemic therapy remains mainly relevant for NF2-related disease, with bevacizumab as proof of concept and multiple pathway-directed agents under evaluation. This narrative review synthesizes these developments and outlines a practical framework to integrate biology and imaging biomarkers into individualized surveillance and treatment selection, while highlighting limitations and priorities for multicenter validation.