听神经瘤治疗进展

Progress on the treatment of vestibular schwannoma

听神经瘤是脑桥小脑角区常见的良性肿瘤,治疗方法主要包括随访观察、立体定向放射治疗和显微外科手术,各有优缺点,标准治疗方法尚存争议。随着对肿瘤进程和治疗认识的深入,较为认可的治疗方案是,初诊的无症状性听神经瘤可采取随访观察或立体定向放射治疗,随访期间若每年肿瘤生长> 2 mm即建议放射治疗;体积较大(直径> 20 mm)的听神经瘤可采取显微外科手术切除,肿瘤体积大、向腹侧生长较多和脑干压迫严重者,可考虑近全切除或次全切除等相对保守的手术策略,并辅以适当的放射治疗;难治性听神经瘤可将靶向药物作为辅助治疗选择。

Vestibular schwannoma is a common benign tumor in the cerehellopontine angle(CPA)The treatment strategy mainly includes follow-up observation,stereotactic radiosurgery(SRT) and microsurgery.Although there are still disputes about the standard treatment methods,each method has its advantages and disadvantages.With the deep understanding of tumor progression and various treatment methods,the widely acceptable treatment is follow-up observation or SRT for the early asymptomatic vestibular schwannoma.During the follow-up period,if the annual tumor growth is more than 2 mm,SRT should be recommended.Large vestibular schwannoma(diameter> 20 mm) can be resected by microsurgery.For large tumors with more ventral growth and severe brain stem compression,relatively conservative surgical strategies such as near total resection(NTR) or subtotal resection(STR) can be considered,supplemented with appropriate SRT.Targeted drug therapy can be used as adjunctive therapy selection for refractory vestibular schwannoma.