外科的介入により音響神経腫患者のQOLが改善される(Study: Surgical Intervention Improves Quality of Life for Patients with Acoustic Neuroma)

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2024-05-23 カリフォルニア大学サンディエゴ校(UCSD)

カリフォルニア大学サンディエゴ校の研究者は、新しい外科手法を用いて聴神経腫を除去することで、患者の聴覚保護と生活の質が向上することを発見しました。この手法により、手術後1年で68%の患者の聴覚が保存され、94%の患者で顔面神経の良好な結果が得られました。中頭蓋窩開頭術を使用して、小さな腫瘍を効果的に除去するこの方法は、特に聴覚を保護しながら腫瘍を除去できる点で有益です。研究成果は、オトロジー&ニューロロジー誌に発表され、聴神経腫の治療における新たな基準を提供します。

<関連情報>

散発性小前庭神経鞘腫患者の中窩開頭術後のQOLについて Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy

Jiramongkolchai, Pawina; Vacaru, Alexandra; La Monte, Olivia; Lee, Joshua; Schwartz, Marc S.; Friedman, Rick A.
Otology & Neurotology  Published:May 21, 2024
DOI: 10.1097/MAO.0000000000004202

Abstract

  • Objective:To evaluate quality-of-life outcomes for patients with vestibular schwannomas (VS) undergoing a middle cranial fossa (MCF) approach.
  • Study Design:Prospective study from 2018 to 2023.
  • Setting:Tertiary academic institution.
  • Patients:Adults with sporadic VS.
  • Interventions:MCF

Main Outcome Measures
The primary outcome measure was the change in preoperative and 1-year postoperative Penn Acoustic Neuroma Quality-of-life (PANQOL) scores. Secondary outcome measures included hearing preservation and facial nerve function.

Results
Of the 164 patients who underwent MCF for sporadic VS, 78 patients elected to voluntarily complete preoperative PANQOL assessments prior to surgery. Seventy-one (91%) of those 78 patients completed postoperative PANQOL surveys. Fifty (70%) of the respondents were female and the median age was 48 years (range, 27–71 years). Overall, at 1-year postsurgery, a minimal clinically important difference (MCID) was obtained in the hearing (mean difference, 10.5; 95% confidence interval [CI], 4.3–16.7) and anxiety (mean difference, 18.8; 95% CI, 11.7–25.9) domains. For patients with hearing preservation (n = 48, 68%), MCIDs were reached in the hearing (mean difference, 13.4; 95% CI, 6.3–20.6), anxiety (mean difference, 20.8; 95% CI, 11.8–29.9), energy (mean difference, 13.7; 95% CI, 3.6–23.8), pain (mean difference, 13.7; 95% CI, 3.6–23.8) domains, and overall PANQOL scores (mean difference, 12.7; 95% CI, 7.1–18.3). Postoperatively, 64 (90%) patients maintained a House-Brackmann I.

Conclusions
To our knowledge, this is the largest study examining disease-specific QOL for VS patients undergoing MCF. Based on our institution’s experience, MCF approach for small VS is associated with clinically meaningful improvements in QOL, hearing preservation, and excellent facial nerve outcomes.

医療・健康
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