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Laryngorhinootologie 2024; 103(03): 176-186
DOI: 10.1055/a-2222-0878
DOI: 10.1055/a-2222-0878
Übersicht
Vestibularisschwannom: Faktoren bei der Therapieentscheidung
Vestibular Schwannoma: Factors in Therapy Decision-Making
Zusammenfassung
Die Behandlung von Vestibularisschwannomen (VS) stellt Ärzte von jeher vor eine Herausforderung. Zur Verfügung stehen 3 wesentliche Behandlungsprinzipien: wait and scan, Operation und stereotaktische Radiochirurgie. Neben der Art der Behandlung ist auch über den richtigen Therapiezeitpunkt, die Kombination verschiedener Behandlungsmodalitäten, den etwaigen chirurgischen Zugang oder die Art und Intensität der Bestrahlung zu entscheiden. Einfluss auf die Therapieentscheidung haben u.a. Tumorlokalisation und -größe bzw. -stadium, das Patientenalter, Komorbiditäten, die Symptomatik, die Möglichkeiten der postoperativen Hörrehabilitation, der Wunsch des Patienten und nicht zuletzt die Erfahrung der Operateure und die personellen und technischen Möglichkeiten des klinischen Standorts.
Dieser Artikel gibt zunächst eine kurze Übersicht über VS, stellt danach die grundsätzlichen interdisziplinären Behandlungsoptionen dar und diskutiert zum Schluss die HNO-relevanten Faktoren bei der Therapieentscheidung.
Abstract
The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and stereotactic radiotherapy. In addition to the type of treatment, decisions must be made regarding the optimal timing of therapy, the combination of different treatment modalities, the potential surgical approach, and the type and intensity of radiation. Factors influencing the therapy decision include tumor location and size or stage, patient age, comorbidities, symptoms, postoperative hearing rehabilitation options, patient preferences, and, not least, the experience of the surgeons and the personnel and technical capabilities of the clinical site. This article begins with a brief overview of vestibular schwannomas, then outlines the fundamental interdisciplinary treatment options, and finally discusses the ENT (ear, nose, and throat)-relevant factors in the therapy decision.
Schlüsselwörter
Vestibularisschwannom - Akustikusneurinom - Radiochirurgie - GammaKnife - CyberKnife - Stereotaxie - Middle fossa approach - transtemporaler Zugang - subtemporaler Zugang - translabyrinthär - Vestibular schwannoma - Acoustic neuroma - Radio surgery - functional neurosurgery - middle fossa approach - subtemporal approachPublication History
Received: 14 July 2023
Accepted after revision: 08 November 2023
Article published online:
21 December 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
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