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Vestibularisschwannom – Management und mikrochirurgische Ergebnisse

Vestibular schwannoma – management and microsurgical results

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Zusammenfassung

Hintergrund

Die Erfahrung eines Behandlungsteams, Interdisziplinarität, die Qualität der Arzt-Patienten-Beziehung, der sinnvolle Einsatz moderner Technik und ein fundiertes Wissen um die Langzeitergebnisse bei Beobachtung und Behandlung bestimmen die Ergebnisqualität bei Patienten mit Vestibularisschwannomen.

Ziele der Arbeit

Der vorliegende Beitrag ist eine Zusammenstellung der aktuellen Befunde zu Ergebnissen bei Beobachtung und mikrochirurgischer Behandlung von Patienten mit solchen Tumoren. Aus diesen Daten werden Prinzipien der medizinischen Versorgung abgeleitet.

Material und Methoden

Die Literatur wurde bezüglich des Verlaufs der Erkrankung bei abwartender Strategie und mikrochirurgischer Behandlung in Bezug auf Tumorwachstum und Symptome ausgewertet.

Ergebnisse

Die jährlichen Wachstumsraten der Tumoren variieren zwischen 0,3 und 4,8 mm. Schwindel ist das Symptom mit dem größten Einfluss auf die Lebensqualität, unabhängig davon, ob behandelt wird oder nicht. Bis zu 75 % der Patienten werden innerhalb der ersten 5 Jahre nach Diagnose behandelt.

Unabhängig vom Zugangsweg werden Tumorresektionsraten von >95 % angegeben, auch wenn der Funktionserhalt in den Vordergrund gestellt wird. Die Rezidivrate nach subtotaler vs. totaler Tumorentfernung wird aktuell mit 3:1 angegeben. Der N. facialis wird in mehr als 90 % funktionell erhalten. Bei gutem Ausgangshörvermögen und kleinen Tumoren ist die Chance der Hörerhaltung höher als 50 %.

Schlussfolgerungen

Die Lebensqualität der Patienten wird in erster Linie durch das Auftreten des Tumors und erst in zweiter Linie durch die Behandlung bestimmt. Die Behandlung sollte von Anfang an auf die Erhaltung der Lebensqualität gerichtet sein. Die Ergebnisse der Behandlung sollten besser sein als der natürliche Verlauf.

Abstract

Background

The experience of the medical team, interdisciplinarity, quality of the physician–patient relationship, sensible use of modern technology, and a sound knowledge about the long-term results of observation and interventions all influence treatment quality in patients with vestibular schwannomas.

Objectives

Compilation of findings regarding the results of observation and microsurgical treatment of patients with these tumors. Deduction of strategies for the medical management from these data.

Materials and methods

Review of the pertinent literature concerning the course of the disease with observational management and microsurgical treatment with respect to tumor growth and symptoms.

Results

Reported annual growth rates of vestibular schwannoma vary between 0.3 and 4.8 mm. Vertigo is the symptom that is most influential on quality of life regardless of the medical management strategy. Up to 75 % of patients are treated within 5 years of the primary diagnosis. Independent of the approach, reported resection rates are higher than 95 %, even with preservation of function as the primary goal. Recurrence rates after subtotal removal are three times higher than after complete removal. Facial nerve preservation is accomplished in more than 90 % of cases. With functional hearing before surgery and small tumors, the chance of hearing preservation exceeds 50 %.

Conclusions

Quality of life is primarily defined by symptoms caused by the tumor itself and only secondarily by the medical interventions. Treatment should be directed towards the preservation of the patient’s quality of life from the beginning. Results of medical treatment should be superior to the natural course of the disease.

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Authors and Affiliations

  1. Klinik für Neurochirurgie, HELIOS Klinikum, Nordhäuser Straße 74, 99089, Erfurt, Deutschland

    S. Rosahl

  2. Klinik für Hals-, Nasen- und Ohrenheilkunde, Plastische Operationen, HELIOS Klinikum, Erfurt, Deutschland

    D. Eßer

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Correspondence to S. Rosahl.

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Interessenkonflikt

S. Rosahl und D. Eßer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rosahl, S., Eßer, D. Vestibularisschwannom – Management und mikrochirurgische Ergebnisse. HNO 65, 381–387 (2017). https://doi.org/10.1007/s00106-016-0252-5

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