Massick D D, Welling D B, Dodson E E, Scholfield M, Nagaraja H N, Schmalbrock P, Chakeres D W
Department of Otolaryngology, The Ohio State University, Columbus 43210, USA.
Laryngoscope. 2000 Nov;110(11):1843-9. doi: 10.1097/00005537-200011000-00015.
To prospectively define the correlation between changes in tumor volume and audiometric function in vestibular schwannomas managed conservatively.
Prospective longitudinal study.
Twenty-one patients (age range, 15-84 y; mean age, 63.3 y) with newly diagnosed vestibular schwannomas were enrolled between 1994 and 1999 in a protocol at The Ohio State University Hospital (Columbus, OH) to evaluate the correlation between tumor volume and audiometric change during a period of observation. Patients were evaluated yearly by clinical examination, a standardized internal auditory canal magnetic resonance imaging scan with gadolinium contrast for volumetric analysis, and audiometric function testing. Demographic data, historical features, neurofibromatosis type 2 (NF2) status, initial testing results, and serial testing results were recorded.
An increase in tumor volume occurred in 14 of the 21 patients (66%). The pattern of volumetric change was found to be extremely variable. Multiple regression analysis revealed significant correlations of changes in tumor volume with changes in pure-tone average and speech discrimination score (P < .0001 and P = .0021, respectively). Change in tumor volume had greater effect on pure-tone average and speech discrimination score in patients initially with class D audiometric function when compared with those initially in class A (P = .0083 and P = .0245, respectively). The presence of NF2 had an independent protective effect against deterioration of the pure-tone average when compared with patients without NF2 (P = .0125).
This study demonstrated a significant correlation between a change in volume and auditory deterioration in vestibular schwannomas being managed with a trial of observation. A given change in tumor volume appeared to have a greater effect on pure-tone average and speech discrimination score as initial auditory classification declined.
前瞻性地确定保守治疗的前庭神经鞘瘤肿瘤体积变化与听力功能之间的相关性。
前瞻性纵向研究。
1994年至1999年间，俄亥俄州立大学医院（俄亥俄州哥伦布市）的一项研究纳入了21例新诊断的前庭神经鞘瘤患者（年龄范围15 - 84岁；平均年龄63.3岁），以评估观察期内肿瘤体积与听力变化之间的相关性。患者每年接受临床检查、标准化的钆增强内耳道磁共振成像扫描以进行体积分析以及听力功能测试。记录人口统计学数据、病史特征、2型神经纤维瘤病（NF2）状态、初始测试结果和系列测试结果。
21例患者中有14例（66%）肿瘤体积增大。发现体积变化模式极具变异性。多元回归分析显示肿瘤体积变化与纯音平均听阈变化和言语辨别得分变化显著相关（分别为P < .0001和P = .0021）。与最初听力分级为A类的患者相比，最初听力分级为D类的患者，肿瘤体积变化对纯音平均听阈和言语辨别得分的影响更大（分别为P = .0083和P = .0245）。与无NF2的患者相比，NF2的存在对纯音平均听阈恶化具有独立的保护作用（P = .0125）。
本研究表明，在采用观察性试验治疗的前庭神经鞘瘤中，体积变化与听力恶化之间存在显著相关性。随着初始听力分级下降，肿瘤体积的给定变化似乎对纯音平均听阈和言语辨别得分有更大影响。
