Kaylie D M, Gilbert E, Horgan M A, Delashaw J B, McMenomey S O
Department of Otolaryngology, Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon 97201, USA.
Otol Neurotol. 2001 Sep;22(5):686-9. doi: 10.1097/00129492-200109000-00022.
The outcomes of surgery for acoustic neuromas have improved dramatically since the development of modern surgical techniques, the operating microscope, magnetic resonance imaging (MRI), and cranial nerve monitoring. The goals of acoustic neuroma surgery are now preservation of facial nerve function and, when feasible, hearing preservation. Many large series do not report standardized hearing and facial function grading, and they include patients who did not benefit from the most modern techniques. The purpose of this study was to present the results of acoustic neuroma surgery using the most modern techniques and equipment, using standardized grading systems.
Retrospective review.
Tertiary referral center.
97 patients who underwent surgical removal of acoustic neuromas from 1992 to 1998.
All patients underwent acoustic neuroma surgery and had preoperative audiograms and MRI with contrast. In addition, all patients had preoperative and postoperative facial function graded by the House-Brackmann scale and intraoperative facial nerve monitoring. Hearing preservation was attempted in patients with tumors of any size who had preoperative function of grade A or B according to the Committee on Hearing and Equilibrium guidelines for reporting results of acoustic neuroma surgery.
Hearing preservation was considered successful if the patient retained serviceable hearing grade A or B. House-Brackmann grade 1 or 2 was considered excellent facial function. Complications were recorded.
Facial nerve integrity was preserved in 96 of 97 patients (99%). Eight of 8 (100%) patients with intracanalicular tumors had excellent facial nerve function (HB 1-2). Fifty-two of 55 (95%) of patients with small tumors had excellent facial nerve function, and 15 of 24 (63%) with medium tumors had HB grade 1-2. Hearing was preserved in 29% of patients with tumors under 2 cm. The overall complication rate was 20%; cerebrospinal fluid leak was the most common.
These results show that with modern imaging and surgical techniques, acoustic neuroma surgery is extremely safe and outcomes are very good. Surgery remains the treatment of choice for most tumors until alternative therapies, such as gamma knife, use uniform grading scales and show long-term facial and hearing results.
自从现代外科技术、手术显微镜、磁共振成像（MRI）以及颅神经监测技术发展以来，听神经瘤手术的效果有了显著改善。如今，听神经瘤手术的目标是保留面神经功能，在可行的情况下保留听力。许多大型研究系列并未报告标准化的听力和面神经功能分级，且纳入了未从最现代技术中获益的患者。本研究的目的是使用最现代的技术和设备，并采用标准化分级系统，呈现听神经瘤手术的结果。
回顾性研究。
三级转诊中心。
1992年至1998年间接受听神经瘤手术切除的97例患者。
所有患者均接受了听神经瘤手术，并进行了术前听力图检查和增强MRI检查。此外，所有患者术前和术后的面神经功能均按照House-Brackmann量表进行分级，并进行术中面神经监测。根据听神经瘤手术结果报告委员会的指南，对于术前听力功能为A或B级的任何大小肿瘤患者，均尝试保留听力。
如果患者保留了A或B级可用听力，则认为听力保留成功。House-Brackmann 1级或2级被认为是优秀的面神经功能。记录并发症情况。
97例患者中有96例（99%）面神经完整性得以保留。8例（100%）内耳道肿瘤患者面神经功能优秀（HB 1-2级）。55例小肿瘤患者中有52例（95%）面神经功能优秀，24例中等大小肿瘤患者中有15例（63%）HB分级为1-2级。肿瘤小于2 cm的患者中，29%的患者听力得以保留。总体并发症发生率为20%；脑脊液漏最为常见。
这些结果表明，借助现代成像和手术技术，听神经瘤手术极其安全，效果非常好。在伽马刀等替代疗法采用统一分级量表并显示长期面神经和听力结果之前，手术仍然是大多数肿瘤的首选治疗方法。
