청신경초종에 대해 의도적 아전절제술 후 감마나이프 수술의 장기 종양조절율과 안면 신경 보존율

• 영문명: Long-term tumor control and facial nerve preservation after attempted subtotal resection with Gamma Knife radiosurgery for vestibular schwannomas
• 발행기관: 대한두개저학회
• 저자명: 김영훈(Young-Hoon Kim) 김진욱(Jin Wook Kim) 김용휘(Yong Hwy Kim) 한정호(Jung Ho Han) 박철기(Chul-Kee Park) 김재용(Chae-Yong Kim) 백선하(Sun Ha Paek) 김동규(Dong Gyu Kim) 정희원(Hee-Won Jung)
• 간행물 정보: 『대한두개저학회지』제7권 제1호, 10~15쪽, 전체 6쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2012.06.30

영문 초록

Objective : Gross total removal(GTR) without neurological impairments for large vestibular schwannoma(VS) has been challenging to neurosurgeons. The purpose of this study was to evaluate long-term surgical and neurological outcome of attempted subtotal removal(STR) followed by Gamma Knife radiosurgery(GKRS) for VS. Methods : A total of 279 patients, who underwent surgical resection with or without GKRS for VS, were enrolled in this study. The median age and follow-up duration were 45 years(range, 19-73) and 5.5 years(2-15), respectively. Two hundred-forty six cases(88.2%) were in Koos grade 3 or 4. GTR or near total removal(NTR), STR, and partial removal(PR) were achieved in 75(26.9%), 160(57.3%), and 44 patients(15.8%), respectively. Adjuvant GKRS were performed in 124 patients(44.4%). Results : The long-term overall tumor control rate was 91.8%(256/279). Of the 160 patients with STR, the tumor control rate was significantly higher in 86 patients who received GKRS(97.7%) than that in 74 patients who did not undergo GKRS(82.4%; p=0.004). However, the adjuvant GKRS did not significantly influence the tumor control rate in GTR, NTR, and PR groups. The functional preservation rate of facial nerve was significantly higher in the STR or PR groups(188/204; 92.2%) than that in the GTR or NTR groups(56/75; 74.7%; p<0.001). Conclusion : Attempted STR with adjuvant GKRS could acquire excellent tumor control and facial never functional outcome of the patients, who underwent surgery for unilateral sporadic VS.

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키워드

vestibular schwannoma subtotal removal radiosurgery facial nerve