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Radiocirurgia versus radiocirurgia precedida por microcirurgia na abordagem ao schwannoma vestibular
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Análise comparativa entre dois grupos de doentes com schwannomas vestibulares, um abordado unicamente por radiocirurgia estereotáxica (RCE) e outro por RCE precedida por microcirurgia. Objetivos: primários: comparação do controlo tumoral, preservação funcional e sintomas associados nos dois grupos. Secundários: estabelecer fatores prognósticos para controlo tumoral e preservação funcional. Materiais e métodos: no grupo da radiocirurgia (grupo A; N=25) a média de volumes tumorais foi 1,64 cm3, com 14 doentes com audição útil, 1 com neuropatia facial, 1 com hipostesia facial, 15 com desequilíbrio e 14 com acufenos. No grupo da radiocirurgia precedida por microcirurgia (grupo B; N=13) a média de volumes tumorais foi 3,75 cm3, com 1 doente com audição útil, 6 com neuropatia facial, 4 com hipostesia facial, 4 com desequilíbrio, 2 com acufenos e 1 com cefaleias. Resultados: a taxa de controlo tumoral foi 92% (A) e 69% (B). A idade, a dose terapêutica, o grau Koos e os fatores de risco vascular não foram significativos como fatores prognósticos para controlo tumoral. A preservação auditiva foi 50 (A) e 0% (B). A dose terapêutica e a idade revelaram valor prognóstico para preservação auditiva (valores-p = 0,018 e 0,037). O mesmo não se verificou para o volume inicial. A taxa de preservação facial foi 96 (A) e 100% (B). O tratamento não se associou a neuropatia facial, vestibular e trigeminal periférica. O volume inicial associou-se significativamente a neuropatia trigeminal periférica (valor-p = 0,034). Estabeleceuse uma relação significativa entre o tratamento e cefaleias em A (valor-p = 0,001). Discussão: o controlo tumoral e a preservação auditiva foram superiores em A. O tratamento associou-se significativamente a deterioração auditiva em A. A dose terapêutica e a idade demonstraram-se valor prognóstico para preservação auditiva; o volume inicial revelou-se como significativo para neuropatia trigeminal periférica. A radiocirurgia associou-se à indução de cefaleias em A.
Comparative analysis between two groups of patients with vestibular schwannomas, one approached by stereotactic radiosurgery alone and another by stereotactic radiosurgery preceded by microsurgery. Objectives: primary: compare differences regarding tumour control, functional preservation and associated symptoms. Secondary: test prognostic factors for tumour control and functional preservation. Materials and methods: in the group of patients submitted solely to radiosurgery (group A; N=25) the mean tumour volume was 1,64 cm3, and there were 14 patients with serviceable hearing, 1 with facial neuropathy, 1 with facial hypoesthesia, 15 with imbalance and 14 with tinnitus. In the group of patients approached by microsurgery followed by radiosurgery (group B; N=13) the mean tumour volume was 3,75 cm3, and there were 1 patient with serviceable hearing, 6 with facial neuropathy, 4 with facial hypoesthesia, 4 with imbalance and 1 with headaches. Results: we attained 92 (A) and 69% (B) tumour control rates. Age, therapeutic dose, Koos grade and vascular risk factors were not significant as prognostic factors for tumour control rate. We achieved a 50 (A) and 0% (B) hearing preservation rates. Therapeutic dose and age were shown to be relevant prognostic factors for hearing preservation (p-values = 0,018 and 0,037, respectively), in opposition to initial volume. Facial preservation rates were 96 (A) and 100% (B). Radiosurgery was not linked to facial, vestibular and peripheral trigeminal neuropathies. Initial volume was statistically linked to peripheral trigeminal deterioration (p-value = 0,034). Radiosurgery was associated with headaches - group A (p-value = 0,001). Discussion: group A had superior tumour control rate and hearing preservation. Radiosurgery was linked to deterioration of hearing function (group A). Therapeutic dose and age were significant as prognostic factors for hearing preservation. Initial volume showed a link as a prognostic factor to peripheral trigeminal deterioration. Treatment showed a link to headaches (group A). Keywords: vestibular schwannoma; stereotactic radiosurgery; microsurgery; tumour control rate; hearing preservation.
Comparative analysis between two groups of patients with vestibular schwannomas, one approached by stereotactic radiosurgery alone and another by stereotactic radiosurgery preceded by microsurgery. Objectives: primary: compare differences regarding tumour control, functional preservation and associated symptoms. Secondary: test prognostic factors for tumour control and functional preservation. Materials and methods: in the group of patients submitted solely to radiosurgery (group A; N=25) the mean tumour volume was 1,64 cm3, and there were 14 patients with serviceable hearing, 1 with facial neuropathy, 1 with facial hypoesthesia, 15 with imbalance and 14 with tinnitus. In the group of patients approached by microsurgery followed by radiosurgery (group B; N=13) the mean tumour volume was 3,75 cm3, and there were 1 patient with serviceable hearing, 6 with facial neuropathy, 4 with facial hypoesthesia, 4 with imbalance and 1 with headaches. Results: we attained 92 (A) and 69% (B) tumour control rates. Age, therapeutic dose, Koos grade and vascular risk factors were not significant as prognostic factors for tumour control rate. We achieved a 50 (A) and 0% (B) hearing preservation rates. Therapeutic dose and age were shown to be relevant prognostic factors for hearing preservation (p-values = 0,018 and 0,037, respectively), in opposition to initial volume. Facial preservation rates were 96 (A) and 100% (B). Radiosurgery was not linked to facial, vestibular and peripheral trigeminal neuropathies. Initial volume was statistically linked to peripheral trigeminal deterioration (p-value = 0,034). Radiosurgery was associated with headaches - group A (p-value = 0,001). Discussion: group A had superior tumour control rate and hearing preservation. Radiosurgery was linked to deterioration of hearing function (group A). Therapeutic dose and age were significant as prognostic factors for hearing preservation. Initial volume showed a link as a prognostic factor to peripheral trigeminal deterioration. Treatment showed a link to headaches (group A). Keywords: vestibular schwannoma; stereotactic radiosurgery; microsurgery; tumour control rate; hearing preservation.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Schwannoma vestibular Radiocirurgia estereotáxica Microcirurgia Taxa de controlo tumoral Preservação auditiva Otorrinolaringologia