Jeyakumar Anita, Seth Rahul, Brickman Todd M, Dutcher Paul
Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Acta Otolaryngol. 2007 Oct;127(10):1051-7. doi: 10.1080/00016480701200210.
This study suggests that among patients diagnosed with 'incidental' acoustic neuromas (ANs), a substantial portion are discovered incidentally. Small and medium-sized ANs that are found incidentally may have a more benign nature, and may be less likely to require interventions.
To estimate the prevalence of ANs, and to compare the prognosis and progression of the disease between those diagnosed incidentally verse symptomatically with an AN.
This was a retrospective evidence-based case series of patients with AN treated at a tertiary medical center between November 1999 and January 2005. An MRI with gadolinium was performed on all patients to establish the diagnosis of AN. A medical chart review of these patients was searched for sex distribution, age, presenting symptoms, hearing loss, speech discrimination scores, tumor characteristics by imaging, intervention performed, and time between diagnosis and intervention. The studied population was divided into those patients with pre-imaging audiovestibular symptoms provoking a clinical suspicion of AN (symptomatic group) and those without a pre-imaging suspicion of AN (incidental group).
The charts of 120 patients with ANs were analyzed and categorized as either incidentally or symptomatically discovered. Incidentally discovered ANs accounted for 12% of patients with the diagnosis of AN in our population. The average age at diagnosis was 55.7 and 52.8 years (p = 0.50) in the symptomatic and incidental groups, respectively. The gender distribution was not different between the groups (p = 0.08). Audiometry revealed a speech discrimination score asymmetry greater in the symptomatic group (p < 0.0001). Tumor size by imaging performed at diagnosis in the incidental population was 1.09 cm on average, compared with 1.5 cm in the symptomatic patients (p = 0.08). A greater proportion of patients with symptomatically discovered AN underwent intervention by surgical resection, stereotactic radiosurgery, or radiation compared with patients with incidentally discovered AN (76% versus 47%, p = 0.02).
本研究表明，在被诊断为“偶然发现”的听神经瘤（AN）患者中，相当一部分是偶然发现的。偶然发现的中小型听神经瘤可能具有更良性的性质，且可能不太需要干预。
评估听神经瘤的患病率，并比较偶然诊断与有症状诊断的听神经瘤患者之间的疾病预后和进展情况。
这是一项基于证据的回顾性病例系列研究，研究对象为1999年11月至2005年1月在一家三级医疗中心接受治疗的听神经瘤患者。所有患者均接受了钆增强磁共振成像（MRI）以确诊听神经瘤。对这些患者的病历进行回顾，以查找性别分布、年龄、出现的症状、听力损失、言语辨别分数、影像学显示的肿瘤特征、所进行的干预措施以及诊断与干预之间的时间。研究人群分为有影像学检查前听觉前庭症状从而引发临床怀疑为听神经瘤的患者（有症状组）和无影像学检查前听神经瘤怀疑的患者（偶然发现组）。
分析了120例听神经瘤患者的病历，并将其分类为偶然发现或有症状发现。在我们的研究人群中，偶然发现的听神经瘤占听神经瘤诊断患者的12%。有症状组和偶然发现组的平均诊断年龄分别为55.7岁和52.8岁（p = 0.50）。两组之间的性别分布无差异（p = 0.08）。听力测定显示，有症状组的言语辨别分数不对称性更大（p < 0.0001）。偶然发现组诊断时通过影像学检查的肿瘤平均大小为1.09厘米，而有症状患者为1.5厘米（p = 0.08）。与偶然发现听神经瘤的患者相比，有症状发现听神经瘤的患者接受手术切除、立体定向放射外科或放射治疗干预的比例更高（76%对47%，p = 0.02）。
