He Yu-Bo, Yu Chun-Jiang, Ji Hong-Ming, Qu Yan-Ming, Chen Ning
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China.
Chin Med J (Engl). 2016 Apr 5;129(7):799-803. doi: 10.4103/0366-6999.178958.
Determining the nerve of origin for vestibular schwannoma (VS), as a method for predicting hearing prognosis, has not been systematically considered. The vestibular test can be used to investigate the function of the superior vestibular nerve (SVN) and the inferior vestibular nerve (IVN). This study aimed to preoperatively distinguish the nerve of origin for VS patients using the vestibular test, and determine if this correlated with hearing preservation.
A total of 106 patients with unilateral VS were enrolled in this study prospectively. Each patient received a caloric test, vestibular-evoked myogenic potential (VEMP) test, and cochlear nerve function test (hearing) before the operation and 1 week, 3, and 6 months, postoperatively. All patients underwent surgical removal of the VS using the suboccipital approach. During the operation, the nerve of tumor origin (SVN or IVN) was identified by the surgeon. Tumor size was measured by preoperative magnetic resonance imaging.
The nerve of tumor origin could not be unequivocally identified in 38 patients (38/106, 35.80%). These patients were not subsequently evaluated. In 26 patients (nine females, seventeen males), tumors arose from the SVN and in 42 patients (18 females, 24 males), tumors arose from the IVN. Comparing with the nerve of origins (SVN and IVN) of tumors, the results of the caloric tests and VEMP tests were significantly different in tumors originating from the SVN and the IVN in our study. Hearing was preserved in 16 of 26 patients (61.54%) with SVN-originating tumors, whereas hearing was preserved in only seven of 42 patients (16.67%) with IVN-originating tumors.
Our data suggest that caloric and VEMP tests might help to identify whether VS tumors originate from the SVN or IVN. These tests could also be used to evaluate the residual function of the nerves after surgery. Using this information, we might better predict the preservation of hearing for patients.
作为预测听力预后的一种方法，确定前庭神经鞘瘤（VS）的起源神经尚未得到系统的考量。前庭测试可用于研究上前庭神经（SVN）和下前庭神经（IVN）的功能。本研究旨在通过前庭测试术前区分VS患者的起源神经，并确定这是否与听力保留相关。
本研究前瞻性纳入了106例单侧VS患者。每位患者在手术前以及术后1周、3个月和6个月接受了冷热试验、前庭诱发肌源性电位（VEMP）测试以及蜗神经功能测试（听力测试）。所有患者均采用枕下入路进行VS手术切除。手术过程中，外科医生确定肿瘤起源神经（SVN或IVN）。术前通过磁共振成像测量肿瘤大小。
38例患者（38/106，35.80%）无法明确确定肿瘤起源神经。这些患者随后未进行评估。26例患者（9例女性，17例男性）的肿瘤起源于SVN，42例患者（18例女性，24例男性）的肿瘤起源于IVN。在本研究中，与肿瘤的起源神经（SVN和IVN）相比，冷热试验和VEMP测试的结果在起源于SVN和IVN的肿瘤中存在显著差异。起源于SVN的肿瘤患者中，26例中有16例（61.54%）听力得以保留，而起源于IVN的肿瘤患者中，42例中仅有7例（16.67%）听力得以保留。
我们的数据表明，冷热试验和VEMP测试可能有助于确定VS肿瘤是起源于SVN还是IVN。这些测试还可用于评估术后神经的残余功能。利用这些信息，我们可能能够更好地预测患者的听力保留情况。
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