Interdisziplinäres Management beim Vestibularisschwannom (Akustikusneurinom) – Aktuelle Strategien der Beratung, Diagnostik und Behandlung

Grundsätzlich muss die Behandlung eines Vestibularisschwannoms für den Patienten besser sein als der natürliche Verlauf. Denn für manche Patienten können die Nebenwirkungen der Behandlung gravierender sein als die Symptome durch den Tumor. Wann sollte man also welches Vestibularisschwannom wie behandeln? Wann kann man beobachtend Zuwarten und was leisten mikrochirurgische Operation und Radiochirurgie? Dieser Beitrag soll die aktuellen Strategien der Beratung, Diagnostik und Behandlung von Patienten mit diesem benignen Tumor aufzeigen.

The treatment of an acoustic neuroma should have a better outcome for the patient than the natural follow-up. That is important because side effects of treatment are sometimes greater than the tumor symptoms. When and how should we treat an acoustic neuroma? Is there a place for wait and scan and what are the results of microsurgery and radiosurgery? In this paper we want show the todays strategies of consultation, diagnostic and therapeutic measures of the patients with this benign tumor.

Acoustic neuroma - management interdisciplinary - microsurgery - radiosurgery - stereotactic radiotherapy

Literatur

• 1 House JW, Brackmann DE. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
• 2 Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery.  Ann Otol Rhinol Laryngol. 1988;  97 55-66
• 3 Myrseth E, Moller P, Wentzel-Larsen T et al.. Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life.  Neurosurgery. 2006;  59 67-76
• 4 Rosahl SK, Samii M. Tumoren des Kleinhirnbrückenwinkels. In: Moskopp D, Wassmann H, (eds) Neurochirurgie. Stuttgart, New York: Schattauer; 2004: 461-472
• 5 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas.  J Neurosurg. 2010;  112 860-867
• 6 Yang I, Sughrue ME, Han SJ et al.. A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma.  J Neurosurg. 2010;  112 851-859
• 7 Yang I, Sughrue ME, Han SJ et al.. Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery.  J Neurooncol. 2009;  93 41-48
• 8 Kano H, Kondziolka D, Niranjan A et al.. Repeat Stereotactic Radiosurgery for Acoustic Neuromas.  Int J Radiat Oncol Biol Phys. 2010;  76 520-527
• 9 Henzel M, Hamm K, Sitter H et al.. Comparison of stereotactic radiosurgery and fractionated stereotactic radiotherapy of acoustic neurinomas according to 3-D tumor volume shrinkage and quality of life.  Strahlenther Onkol. 2009;  185 567-573
• 10 Rowe JG, Radatz MW, Walton L et al.. Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas.  J Neurol Neurosurg Psychiatry. 2003;  74 1536-1542
• 11 Combs SE, Welzel T, Schulz-Ertner D et al.. Differences in Clinical Results after LINAC-Based Single-Dose Radiosurgery Versus Fractionated Stereotactic Radiotherapy for Patients with Vestibular Schwannomas.  Int J Radiat Oncol Biol Phys. 2010;  76 193-200
• 12 Sughrue ME, Yang I, Aranda D et al.. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes.  J Neurosurg. 2010;  112 163-167
• 13 Roche PH, Khalil M, Thomassin JM. Microsurgical removal of vestibular schwannomas after failed previous microsurgery.  Prog Neurol Surg. 2008;  21 158-162
• 14 Roche PH, Khalil M, Thomassin JM et al.. Surgical removal of vestibular schwannoma after failed gamma knife radiosurgery.  Prog Neurol Surg. 2008;  21 152-157
• 15 Myrseth E, Moller P, Pedersen PH et al.. Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.  Neurosurgery. 2005;  56 927-935
• 16 Caffier PP, Haupt H, Scherer H, Mazurek B. Outcomes of long-term outpatient tinnitus-coping therapy: psychometric changes and value of tinnitus-control instruments.  Ear Hear. 2006;  27 619-627

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