不完全显微外科切除后残留前庭神经鞘瘤的自然史：长期监测中的延迟进展
Natural History of Residual Vestibular Schwannoma After Incomplete Microsurgical Resection: Delayed Progression During Long-Term Surveillance.
文献信息
| PMID | 42880708 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Julia Shawarba |
| 作者单位 | Department of Neurosurgery, Medical University Vienna, Vienna, A-1090 Austria; Comprehensive Center of Clinical Neurosciences and Mental Health, Medical University Vienna, Vienna, A-1090 Austria. |
| 期刊 | World neurosurgery |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 为保留颅神经功能，前庭神经鞘瘤（VS）的故意不完全切除正日益被接受，但残留肿瘤的长期行为仍不确定。我们描述了在延长影像学监测期间残留VS的自然史。
方法： 在2013年至2019年间于单中心接受VS显微手术的194例患者中，68例具有完整的术前和术后MRI并构成研究队列；22例（32%）在基线MRI上有残留肿瘤并构成分析人群。进展定义为最大线性直径增加≥2 mm。采用Kaplan-Meier法估计无进展生存期（PFS）；通过log-rank检验和Cox回归探讨残留大小（<10 mm vs. ≥10 mm）。
结果： 中位年龄为56岁（范围25-72），13例患者（59%）为女性，中位随访时间为84个月（范围37-144）。12例患者（55%）显示进展，其中5例（42%）在手术后5年以上；3个残留肿瘤消退。中位PFS为81个月（95% CI，35-127）；3年PFS为77%，5年PFS为68%。残留大小与进展无显著相关性（log-rank p = 0.48；≥10 mm的风险比为1.71；95% CI，0.38-7.79）。6例患者（27%）接受了二次治疗（手术，n = 4；放射外科，n = 2）。
结论： 在这个小队列中，超过一半的残留VS出现进展，且常在5年以上。这些数据支持在不完全切除后MRI监测可延长至5年以上的可行性，但并未确立其比较安全性或有效性。
英文摘要
BACKGROUND: Deliberate incomplete resection of vestibular schwannoma (VS) is increasingly accepted to preserve cranial nerve function, but the long-term behaviour of remnants remains uncertain. We describe the natural history of residual VS during extended radiological surveillance.
METHODS: Of 194 patients who underwent VS microsurgery at a single centre between 2013 and 2019, 68 had complete pre- and postoperative MRI and formed the study cohort; 22 (32%) had a residual tumour on baseline MRI and constituted the analysis population. Progression was defined as a ≥2-mm increase in maximum linear diameter. Progression-free survival (PFS) was estimated with the Kaplan-Meier method; residual size (<10 mm vs. ≥10 mm) was explored with log-rank tests and Cox regression.
RESULTS: Median age was 56 years (range, 25-72), 13 patients (59%) were female, and median follow-up was 84 months (range, 37-144). Twelve patients (55%) showed progression, 5 of them (42%) more than 5 years after surgery; 3 remnants regressed. Median PFS was 81 months (95% CI, 35-127); PFS was 77% at 3 years and 68% at 5 years. Residual size was not significantly associated with progression (log-rank p = 0.48; hazard ratio for ≥10 mm, 1.71; 95% CI, 0.38-7.79). Six patients (27%) received secondary treatment (surgery, n = 4; radiosurgery, n = 2).
CONCLUSIONS: In this small cohort, more than half of residual VS progressed, often beyond 5 years. These data support the feasibility of MRI surveillance extending beyond 5 years after incomplete resection but do not establish its comparative safety or effectiveness.