Principi modernog liječenja Schwannoma nervus statoakustikusa

master's thesis

• Title (english): Current principles in the treatment of vestibular Schwannoma
• Author: Pia Saskia Müller
• Mentor: Goran Mrak (mentor)
• Committee member: Darko Chudy (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Mrak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Vestibularni schwannomi (VS) benigni su tumori koji svojim rastom i kompresijom ostalih živčanih struktura uzrokuju raznolike simptome. Njihovo liječenje sastoji se od konzervativnog liječenja, stereotaksijske radiokirurgije, mikroneurokirurgije te iznimno
monoklonskih protutijela u neurofibromatozi tip 2. Konzervativno liječenje primijenjivo je u pacijenata s malim i spororastućim tumorima s nikakvim ili tek minimalnim simptomima te u pacijenata čija dob ili trenutno zdravstveno stanje nije kompatibilno s
radikalnom terapijom. Radiokirurgija Gamma nožem jednokratna je, bezbolna i neinvazivna terapijska opcija koja je moguća u pacijenata čiji tumori ne prelaze više od 3 cm, a djeluje na tumorsko tkivo tako da zaustavlja njegov rast (u 36% slučajeva) ili ga smanjuje (u 56% slučajeva). Mikroneurokirurgiji pak podliježu pacijenti mlađi od 65 godina s velikim i rastućim tumorima, sa značajnim gubitkom sluha ili s prisutnim većim ukupnim brojem simptoma. Mikrokirurška terapija može se izvesti jednim od tri
pristupa; translabirintni, retrosigmoidni te pristup srednjoj lubanjskoj jami. Translabirnitni pristup prigodan je za veće tumore s prisutnim simptomom gluhoće budući da se operacijom trajno žrtvuje sluh. Retrosigmoidni pristup omogućuje prostranu vizualizaciju stražnje lubanjske jame te se njime mogu operirati tumori svih veličina. Pristup srednje lubanjske jame rezerviran je za intrakanalikularne tumore ili one čija ekstrameatalna procija ne iznosi više od 1 cm budući pristup ne omogućuje dobru
vizualizaciju stražnje lubanjske jame. U posljednje vrijeme glavni cilj neurokirurške obrade pacijenta s VS više nije ekscizija tumora pod svaku cijenu već dugotrajno očuvanje funkcije VIII i VII kranijalnog živca.

Abstract (english)

Vestibular schwannomas (VS) are benign tumors that cause a variety of symptoms due to their growth and mass effect on other nerve structures. Treatment consists of conservative treatment, stereotactic radiosurgery, microneurosurgery and
exceptionally monoclonal antibodies in neurofibromatosis type 2. Conservative treatment is applicable in patients with small and slow-growing tumors with no or only minimal symptoms and in patients whose age or current medical condition isn't compatible to radical treatment. Gamma knife radiosurgery is a one-time, painless and non-invasive therapeutic option that is possible in patients whose tumors do not exceed 3 cm, and it acts by stopping its growth (in 36% of cases) or reducing its' size (in 56% of cases). Patients under the age of 65 with large and tumors increasing in size, with significant hearing loss or with a higher total number of symptoms are subject to microneurosurgery. Microsurgical therapy can be reported by one of three approaches; translabyrinthine, retrosigmoid and middle cranial fossa approach. The translabyrinthine approach is suitable for larger tumors with a deafness present as surgery permanently sacrifices hearing. The retrosigmoid approach enables extensive visualization of the posterior cranial fossa and can be used to operate on tumors of all sizes. The middle cranial fossa approach is reserved for intracanalicular tumors or those whose extrameatal part is not larger than 1 cm since the approach does not allow good visualization of the posterior cranial fossa. Recently, the main goal of neurosurgical treatment of a patient with VS switched from excision of the tumor to long-term preservation of the function of the VIII and VII cranial nerve.

• Keywords: vestibularni schwannom; akustični neurom; principi liječenja
• Keywords (english): vestibular schwannoma; acoustic neuroma; treatment principles
• Language: croatian
• URN:NBN: urn:nbn:hr:105:177029
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-21 10:34:37