Chen Brian S, Roberts Daniel S, Lekovic Gregory P
House Clinic, Los Angeles, California, United States.
J Neurol Surg Rep. 2016 Mar;77(1):e001-7. doi: 10.1055/s-0035-1564604. Epub 2015 Dec 2.
Background Rates of hearing preservation following surgery via middle fossa craniotomy in patients harboring tumors with unfavorable characteristics are significantly lower than for those patients with "favorable" tumors. Objectives We will present two cases both with unfavorable conditions, which underwent endoscopic-assisted middle fossa craniotomy (MFC) resection of intracanalicular vestibular schwannomas with preserved postoperative hearing. Methods Chart reviews were conducted on both patients. Their presentation, intraoperative details, and techniques, pre- and postoperative audiograms, and facial nerve outcomes are presented. Results Patient A had 5.6 × 6.8 × 13.2 mm intracanalicular tumor with unserviceable hearing (pure tone audiometry [PTA], 41; speech determination score [SDS], 47%; class D) but was blind so hearing preservation was attempted. Postoperative hearing was preserved (PTA, 47; SDS, 60%; class B). Patient B had a 5 mm round intracanalicular tumor immediately adjacent to the vestibule and cochlea without any fundal fluid present. Preoperative audiogram showed serviceable hearing (PTA, 48; SDS, 88%; class B). Postoperatively, aidable hearing was preserved (PTA, 51; SDS, 76%; class C). Conclusion Hearing preservation surgery via MFC can be enhanced with endoscopic-assisted dissection, especially in the lateral internal auditory canal. The superior optical view allows for preservation of cochlear nerve function and removal of residual tumor not otherwise seen on microscopy.
对于患有特征不佳肿瘤的患者，经中颅窝开颅手术术后听力保留率显著低于患有“有利”肿瘤的患者。目的：我们将介绍两例情况不佳的患者，他们接受了内镜辅助下中颅窝开颅术（MFC）切除内听道前庭神经鞘瘤，术后听力得以保留。方法：对两名患者进行病历回顾。呈现了他们的临床表现、术中细节及技术、术前和术后听力图以及面神经结果。结果：患者A患有大小为5.6×6.8×13.2mm的内听道肿瘤，听力丧失（纯音听力测定[PTA]，41；言语识别得分[SDS]，47%；D级），但失明，因此尝试保留听力。术后听力得以保留（PTA，47；SDS，60%；B级）。患者B有一个5mm圆形内听道肿瘤，紧邻前庭和耳蜗，无任何基底液。术前听力图显示听力尚可（PTA，48；SDS，88%；B级）。术后，辅助听力得以保留（PTA，51；SDS，76%；C级）。结论：内镜辅助下分离可提高经MFC进行的听力保留手术的效果，尤其是在内侧内听道。优越的视野有助于保留蜗神经功能并切除显微镜下无法看到的残留肿瘤。
