PDF(Pubmed)
Abstract：
Stereotactic radiosurgery (SRS) is an effective treatment for vestibular schwannomas, offering high rates of tumor control and low neurological risks. Long-term complications of SRS are not fully understood, with several cases of malignant transformation reported in the literature. We report the case of a 50-year-old female with no prior history of neurofibromatosis who presented in 2013 with MRI evidence of a benign vestibular schwannoma. Despite treatment with CyberKnife SRS, she presented 6 years later with new onset neurologic symptoms. Further investigation showed stable lesion size with increasing vasogenic edema and a new area of enhancement in the brainstem, suspicious for malignant transformation. Subsequent treatment with partial craniectomy and histopathologic analysis was consistent with a malignant peripheral nerve sheath tumor diagnosis. Our case adds to a series of 24 similar cases in the literature, details of which have been summarized in our study. Overall, findings support the need for lifelong surveillance following SRS treatment of benign vestibular schwannomas. Patients should be educated on the potential risk of this complication, and clinicians must maintain a high level of suspicion for potential radiation-induced malignancy during the patient\'s clinical course.
摘要：
立体定向放射外科（SRS）是前庭神经鞘瘤的有效治疗方法，提供高肿瘤控制率和低神经风险。SRS的长期并发症尚未完全了解，文献中报道了几例恶性转化。我们报告了一名50岁的女性，没有神经纤维瘤病的病史，该患者于2013年出现了良性前庭神经鞘瘤的MRI证据。尽管用射波刀SRS治疗,6年后，她出现了新的神经系统症状。进一步的研究显示病灶大小稳定，血管源性水肿增加，脑干有新的增强区域，怀疑恶性转化。随后的部分颅骨切除术和组织病理学分析与恶性周围神经鞘瘤诊断一致。我们的案例增加了文献中的一系列24个类似案例，其细节已在我们的研究中进行了总结。总的来说,研究结果支持SRS治疗良性前庭神经鞘瘤后需要进行终身监测.应该对患者进行这种并发症的潜在风险的教育，在患者的临床过程中，临床医生必须高度怀疑潜在的放射性恶性肿瘤。
