Departments of 1 Neurological Surgery and.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Neurosurg. 2016 Oct;125(4):845-852. doi: 10.3171/2015.8.JNS151624. Epub 2016 Jan 8.
OBJECTIVE In the era of MRI, vestibular schwannomas are often recognized when patients still have excellent hearing. Besides success in tumor control rate, hearing preservation is a main goal in any procedure for management of this population. The authors evaluated whether modified auditory subclassification prior to radiosurgery could predict long-term hearing outcome in this population. METHODS The authors reviewed a quality assessment registry that included the records of 1134 vestibular schwannoma patients who had undergone stereotactic radiosurgery during a 15-year period (1997-2011). The authors identified 166 patients who had Gardner-Robertson Class I hearing prior to stereotactic radiosurgery. Fifty-three patients were classified as having Class I-A (no subjective hearing loss) and 113 patients as Class I-B (subjective hearing loss). Class I-B patients were further stratified into Class I-B1 (pure tone average ≤ 10 dB in comparison with the contralateral ear; 56 patients), and I-B2 (> 10 dB compared with the normal ear; 57 patients). At a median follow-up of 65 months, the authors evaluated patients' hearing outcomes and tumor control. RESULTS The median pure tone average elevations after stereotactic radiosurgery were 5 dB, 13.5 dB, and 28 dB in Classes I-A, I-B1, and I-B2, respectively. The median declines in speech discrimination scores after stereotactic radiosurgery were 0% for Class I-A (p = 0.33), 8% for Class I-B1 (p < 0.0001), and 40% for Class I-B2 (p < 0.0001). Serviceable hearing preservation rates were 98%, 73%, and 33% for Classes I-A, I-B1, and I-B2, respectively. Gardner-Robertson Class I hearing was preserved in 87%, 43%, and 5% of patients in Classes I-A, I-B1, and I-B2, respectively. CONCLUSIONS Long-term hearing preservation was significantly better if radiosurgery was performed prior to subjective hearing loss. In patients with subjective hearing loss, the difference in pure tone average between the affected ear and the unaffected ear was an important factor in long-term hearing preservation.
在 MRI 时代，当患者仍具有良好的听力时，通常会发现前庭神经鞘瘤。除了在肿瘤控制率方面取得成功外，听力保留也是此类人群管理中任何治疗方法的主要目标。作者评估了在放射外科治疗前对听力进行改良分类是否可以预测此类人群的长期听力结果。
作者回顾了一个质量评估登记处，其中包括在 15 年期间（1997 年至 2011 年）接受立体定向放射外科治疗的 1134 例前庭神经鞘瘤患者的记录。作者确定了 166 例在立体定向放射外科治疗前具有 Gardner-Robertson Ⅰ级听力的患者。53 例被归类为Ⅰ-A 级（无主观听力损失），113 例为Ⅰ-B 级（主观听力损失）。Ⅰ-B 级患者进一步分为Ⅰ-B1 级（与对侧耳相比纯音平均≤10 dB；56 例）和Ⅰ-B2 级（与正常耳相比>10 dB；57 例）。在中位数为 65 个月的随访中，作者评估了患者的听力结果和肿瘤控制情况。
立体定向放射外科治疗后，Ⅰ-A、Ⅰ-B1 和Ⅰ-B2 级的纯音平均升高中位数分别为 5 dB、13.5 dB 和 28 dB。立体定向放射外科治疗后言语辨别评分中位数下降分别为Ⅰ-A 级 0%（p=0.33）、Ⅰ-B1 级 8%（p<0.0001）和Ⅰ-B2 级 40%（p<0.0001）。Ⅰ-A、Ⅰ-B1 和Ⅰ-B2 级的可听保留率分别为 98%、73%和 33%。Ⅰ-A、Ⅰ-B1 和Ⅰ-B2 级患者的 Gardner-RobertsonⅠ级听力保留率分别为 87%、43%和 5%。
如果在主观听力损失之前进行放射外科治疗，长期听力保留明显更好。对于有主观听力损失的患者，受影响耳与未受影响耳之间的纯音平均值差异是长期听力保留的重要因素。
