Bozorg Grayeli Alexis, Refass Afaf, Smail Mustapha, Elgarem Hani, Kalamarides Michel, Bouccara Didier, Sterkers Olivier
Otolaryngology Department, AP-HP, Hôpital Beaujon, Clichy, France.
Acta Otolaryngol. 2008 Oct;128(10):1096-100. doi: 10.1080/00016480701881803.
Auditory brainstem responses (ABRs) associated with other audio-vestibular examinations and a thorough clinical examination should allow detection of the majority of cerebellopontine angle (CPA) lesions (99.2-100%).
The increasing quality of MRI in the detection of CPA lesions, and the reports of false negative ABRs have raised issues concerning the value of ABR in the diagnosis and preoperative assessment of CPA lesions. The aim of this work was to assess the value of the ABR in the diagnosis of vestibular schwannomas (VS) and other CPA lesions.
This retrospective study included 676 solitary VS (548 operated on and 128 followed up) and 70 other CPA tumours (72% meningiomas, 11% cholesteatomas, 3% ependymomas, 15% miscellaneous) managed between 1990 and 2001. All patients underwent clinical examination, audiometry, ABR, vestibular caloric tests and MRI.
ABRs were normal in 4.8% of VS. Association of normal ABR, vestibular caloric tests and audiometry (AAO-HNS class A) represented only 0.7% of VS. In other CPA lesions, ABR were normal in 15% of cases and the association of the three above-mentioned examinations was encountered in 10%. However, in the latter cases the clinical examination showed an abnormality in all cases.
与其他听-前庭检查及全面的临床检查相结合的听觉脑干反应（ABR）应能检测出大多数桥小脑角（CPA）病变（99.2 - 100%）。
MRI在检测CPA病变方面质量不断提高，且有ABR假阴性的报道，这引发了关于ABR在CPA病变诊断及术前评估中价值的问题。本研究的目的是评估ABR在前庭神经鞘瘤（VS）及其他CPA病变诊断中的价值。
这项回顾性研究纳入了1990年至2001年间治疗的676例孤立性VS（548例接受手术，128例接受随访）以及70例其他CPA肿瘤（72%为脑膜瘤，11%为胆脂瘤，3%为室管膜瘤，15%为其他）。所有患者均接受了临床检查、听力测定、ABR、前庭冷热试验及MRI检查。
4.8%的VS患者ABR正常。ABR正常、前庭冷热试验及听力测定均正常（AAO - HNS A级）的VS患者仅占0.7%。在其他CPA病变中，15%的病例ABR正常，上述三项检查均正常的情况占10%。然而，在后一种情况下，所有病例的临床检查均显示异常。
