聴神経腫瘍—耳鼻咽喉科の立場から

Management of Vestibular Schwannoma by Otolaryngologists

Point

・Koos Ⅰ〜Ⅲの小・中型腫瘍のマネジメントが耳鼻咽喉科に求められている役割である．

・早期に発見された小・中型腫瘍に増大傾向がみられた場合，そして聴力の悪化がみられた場合に積極的な治療介入を検討する．

・手術と定位放射線照射の選択は，50歳以下は手術を優先して，70歳以上は定位放射線照射を優先して検討する．

・耳鼻咽喉科による手術には中頭蓋窩法，経迷路法，後迷路法などがあり，それぞれの適応について解説する．

　Small-to-medium-sized vestibular schwannomas are frequently managed initially by otolaryngologists because hearing loss, tinnitus, and dizziness, the most common presenting symptoms, lead patients to seek otolaryngologic care. Surgical intervention is often considered for patients aged＜50 years, whereas radiotherapy is recommended for those aged＞70 years. Patient preferences are crucial in treatment decisions. For small-to-medium-sized tumors, complete facial nerve preservation is a primary surgery goal. Surgical approach selection depends on the tumor size and patient's hearing status, with options including the middle cranial fossa, translabyrinthine, and retrolabyrinthine approaches.