Belal A
Alexandria Ear Hospital, Alexandria, Egypt.
Otol Neurotol. 2001 Jul;22(4):497-500. doi: 10.1097/00129492-200107000-00015.
This study aimed to assess the possibility of hearing restoration after acoustic tumor removal.
Hearing restoration surgery may be indicated after surgery of bilateral acoustic tumors or surgery of acoustic tumor in the only hearing ear. The choice is between cochlear implantation and brainstem implantation.
From the temporal bone collection at the House Ear Institute, Los Angeles, the author histologically examined eight temporal bones from seven patients who had undergone acoustic tumor removal during their lifetime. Special emphasis was put on examining the patency of the cochlear turns and on survival of the spiral ganglion cells and cochlear nerve.
This study showed that after translabyrinthine acoustic tumor removal, there is progressive osteoneogenesis of the cochlea associated with almost complete degeneration of the spiral ganglion cells and cochlear nerve. Similar findings were noticed after middle fossa removal of acoustic tumor with unsuccessful hearing preservation.
The histologic changes described in the cochlea and cochlear nerve represent the effects of ischemia resulting from inadvertent cutting of the blood supply during acoustic tumor removal. It is possible to do cochlear implantation after acoustic tumor removal provided that the result of promontory electrical stimulation test is positive (the cochlear nerve is intact) and that implantation is done at the time of acoustic tumor removal or shortly thereafter, before cochlear ossification is complete.
本研究旨在评估听神经瘤切除术后听力恢复的可能性。
双侧听神经瘤手术后或仅存听力耳的听神经瘤手术后，可能需要进行听力恢复手术。选择在于人工耳蜗植入和脑干植入。
作者从洛杉矶豪斯耳科研究所的颞骨收藏中，对7例一生中接受过听神经瘤切除手术的患者的8块颞骨进行了组织学检查。特别着重检查耳蜗各圈的通畅情况以及螺旋神经节细胞和蜗神经的存活情况。
本研究表明，经迷路听神经瘤切除术后，耳蜗有进行性骨生成，同时螺旋神经节细胞和蜗神经几乎完全退化。在中颅窝切除听神经瘤且听力保留未成功后也观察到类似结果。
耳蜗和蜗神经中描述的组织学变化代表了听神经瘤切除过程中意外切断血供导致的缺血效应。听神经瘤切除术后，只要鼓岬电刺激试验结果为阳性（蜗神经完整），并且在听神经瘤切除时或此后不久、在耳蜗骨化完成之前进行植入，就有可能进行人工耳蜗植入。
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