手术、放疗或观察对前庭神经鞘瘤患者客观前庭功能、前庭症状及生活质量的影响
Effects of surgery, radiotherapy or surveillance on the objective vestibular function, vestibular symptoms and quality of life in vestibular schwannoma patients.
文献信息
| PMID | 42900197 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Constanza Fuentealba Bassaletti |
| 作者单位 | Department of Otorhinolaryngology / Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands. c.a.fuentealba_bassaletti@lumc.nl. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 评估主动观察、放疗和手术对单侧前庭神经鞘瘤（VS）患者前庭功能、前庭症状及生活质量的影响。
方法： 在这项于三级转诊中心开展的前瞻性纵向研究中，患者在治疗前后接受冷热试验和视频头脉冲试验（vHIT），并完成头晕残障量表（DHI）和Penn听神经瘤生活质量（PANQOL）问卷，随访按治疗方式区分：观察开始后6、12和24个月，放疗后6周、6和12个月，手术后1、3和12个月。纵向变化采用重复测量方差分析。
结果： 与基线相比，主动观察组（57%）和手术组（93%）的冷热试验异常百分比保持稳定，但放疗组在干预后12个月显著升高（从77%升至92%；p=0.02）。所有手术患者在术后1个月均显示vHIT增益异常，而主动观察组（33%）和放疗组（85%）的异常逐渐增加。前庭症状在主动观察期间保持稳定，放疗后增加，手术后减少。12个月时，各组间DHI和PANQOL评分不再存在显著或临床差异。
结论： 主动观察与最稳定的客观和主观前庭功能相关。手术导致即刻前庭功能恶化，而放疗对中长期前庭功能有延迟的相当效应。尽管基线存在差异，治疗或观察开始12个月后各组间前庭症状和生活质量无显著差异。
证据等级： II级。
英文摘要
OBJECTIVE: To evaluate the effect of active surveillance, radiotherapy and surgery on the vestibular function, vestibular symptoms, and quality of life in unilateral vestibular schwannoma (VS) patients.
METHODS: In this prospective longitudinal study at a tertiary referral center, patients underwent caloric and video head impulse (vHIT) testing and completed the Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaires before and after treatment, with treatment-specific follow-up: at 6, 12 and 24 months after surveillance start, at 6 weeks, 6 and 12 months after radiotherapy, and 1, 3, and 12 months after surgery. Longitudinal changes were analyzed using repeated-measures ANOVA.
RESULTS: Compared with baseline, the percentage of abnormal caloric tests remained stable in the active surveillance (57%) and surgery groups (93%), but increased significantly in the radiotherapy group (from 77% to 92%; p= 0.02) at 12 months after intervention. All surgical patients showed abnormal vHIT gains one month after surgery, whereas abnormalities gradually increased in the active surveillance (33%) and radiotherapy (85%) groups. Vestibular symptoms remained stable during active surveillance, increased after radiotherapy, and decreased after surgery. At 12 months, DHI and PANQOL scores no longer differed significantly or clinically between groups.
CONCLUSION: Active surveillance was associated with the most stable objective and subjective vestibular function. Surgery caused immediate vestibular deterioration, whereas radiotherapy had a delayed comparable effect on mid- to long-term vestibular function. Despite baseline differences, vestibular symptoms and quality of life did not differ significantly between groups 12 months after treatment or initiation of surveillance.
LEVEL OF EVIDENCE: Level II.