Wertigkeit unterschiedlicher Methoden zur Behandlung von Akustikusneurinomen

Differenzialtherapeutische Aspekte und Literaturauswertung

Value of different strategies in the treatment of vestibular schwannoma

Therapeutic aspects and literature analysis

Zusammenfassung

Das Therapiespektrum beim Akustikusneurinom hat sich erweitert und differenziert. Eine Auswertung der internationalen Literatur mittels selektiver PubMed-Recherche zeigt, dass otochirurgische, neurochirurgische und radiotherapeutische Verfahren sowie die Wait-and-Scan-Option nicht nur konkurrieren, sondern auch komplementäre Aspekte aufweisen. Standardisierte Schemata zur Klassifizierung von Hörvermögen, Gesichtsnervenfunktion und Lebensqualität ermöglichen einen besseren Vergleich der funktionellen Ergebnisse. Für alle Verfahren wichtig sind der Standard des Erhalts der Fazialisfunktion und möglichst des Hörvermögens, vestibuläre Aspekte und die Lebensqualität, auch im Langzeitverlauf. Neben einer effektiven Tumorkontrolle steht die Minimierung von Morbidität im Vordergrund. Besonders anspruchsvoll ist die Abwägung der Optionen bei Patienten mit Neurofibromatose Typ 2 (NF-2) und bei Rezidivtumoren. Die komplexe Thematik verlangt von beratenden und behandelnden Ärzten fundierte Kenntnisse aktueller differenzialtherapeutischer Aspekte. Deshalb sollte die individuelle Therapieempfehlung in einem spezialisierten Zentrum erfolgen.

Abstract

Treatment strategies for vestibular schwannoma have been extended and become more differentiated. An analysis of the international literature with the help of a PubMed search shows that otological and neurosurgical procedures as well as radiation therapies do not only compete but also complement each other. Standardized protocols for the classification of hearing, facial nerve function and quality of life enable a better comparison of functional results. Recent publications discuss – in addition to the standard of preserving facial nerve function and hearing – aspects of vestibular function as well as quality of life, especially in long-term follow up. In addition to effective tumour control, major focus is put on minimizing morbidity. The choice of therapy in patients with neurofibromatosis 2 and recurrent tumours is particularly challenging. The complex topic requires a profound knowledge of differential therapeutic aspects from consulting and treating physicians. Therefore, the individual treatment recommendation should be given in a specialized center.

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Maier, W., Grauvogel, T., Laszig, R. et al. Wertigkeit unterschiedlicher Methoden zur Behandlung von Akustikusneurinomen. HNO 59, 425 (2011). https://doi.org/10.1007/s00106-011-2302-3

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Schlüsselwörter

  • Akustikusneurinom
  • Vestibularisschwannom
  • Mikrochirurgie
  • Stereotaktische Radiochirurgie
  • Lebensqualität

Keywords

  • Acoustic neuroma
  • Vestibular schwannoma
  • Microsurgery
  • Stereotactic radiosurgery
  • Quality of life