Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Neurosurg Focus. 2012 Sep;33(3):E10. doi: 10.3171/2012.7.FOCUS12172.
In the early 1960s William F. House developed the middle fossa approach for the removal of small vestibular schwannomas (VSs) with the preservation of hearing. It is the best approach for tumors that extend laterally to the fundus of the internal auditory canal, although it does have the potential disadvantage of increased facial nerve manipulation, especially for tumors arising from the inferior vestibular nerve. The aim of this study was to monitor the hearing preservation and facial nerve outcomes of this approach.
A prospective database was constructed, and data were retrospectively reviewed.
Between December 2004 and January 2012, 30 patients with small VSs underwent surgery via a middle fossa approach for hearing preservation. The patients consisted of 13 men and 17 women with a mean age of 46 years. Tumor size ranged from 7 to 19 mm. Gross-total resection was accomplished in 25 of 30 patients. Preoperative hearing was American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Class A in 21 patients, Class B in 5, Class C in 3, and undocumented in 1. Postoperatively, hearing was graded as AAO-HNS Class A in 15 patients, Class B in 7, Class C in 1, Class D in 2, and undocumented in 5. Facial nerve function was House-Brackmann (HB) Grade I in all patients preoperatively. Postoperatively, facial nerve function was HB Grade I in 28 patients, Grade III in 1, and Grade IV in 1. There were 3 complications: CSF leakage in 1 patient, superficial wound infection in 1, and extradural hematoma (asymptomatic) in 1. The overall hearing preservation rate of at least 73% and HB Grade I facial nerve outcome of 93% in this cohort are in keeping with other contemporary reports.
The middle fossa approach for the resection of small VSs with hearing preservation is a viable and relatively safe option. It should be considered among the various options available for the management of small, growing VSs.
20 世纪 60 年代初，William F. House 开发了中颅窝入路，用于切除小前庭神经鞘瘤（VSs）并保留听力。对于向内侧延伸至内听道底部的肿瘤，这是最佳的手术入路，尽管它确实存在面神经操作增加的潜在风险，尤其是对于起源于下前庭神经的肿瘤。本研究旨在监测该手术入路对面神经保留和听力的影响。
构建了一个前瞻性数据库，并对数据进行了回顾性分析。
2004 年 12 月至 2012 年 1 月，30 例小 VSs 患者接受了中颅窝入路手术以保留听力。患者包括 13 名男性和 17 名女性，平均年龄为 46 岁。肿瘤大小范围为 7 至 19mm。25 例患者实现了大体全切除。术前听力根据美国耳鼻喉科学-头颈外科学会（AAO-HNS）标准为 A 级 21 例，B 级 5 例，C 级 3 例，未记录 1 例。术后听力评定为 A 级 15 例，B 级 7 例，C 级 1 例，D 级 2 例，未记录 5 例。术前所有患者面神经功能均为 House-Brackmann（HB）Ⅰ级。术后，28 例患者面神经功能为 HB Ⅰ级，1 例为Ⅲ级，1 例为Ⅳ级。有 3 例并发症：1 例患者发生脑脊液漏，1 例患者发生浅表伤口感染，1 例患者发生硬膜外血肿（无症状）。该队列的总体听力保留率至少为 73%，HB Ⅰ级面神经结果为 93%，与其他当代报告一致。
对于小 VSs 的听力保留切除，中颅窝入路是一种可行且相对安全的选择。对于小、生长中的 VSs 的治疗，应考虑多种治疗方案。
