Plontke S, Kösling S, Pazaitis N, Rahne T
Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Klinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
HNO. 2017 Jul;65(7):610-616. doi: 10.1007/s00106-017-0347-7.
We report about a patient who in 2005, aged 37 years, experienced sudden mild to moderate, mid-frequency sensorineural hearing loss in the right ear along with tinnitus and mild dizziness. MRI of the temporal bone revealed a very small (1 mm) contrast-enhancing lesion in the second turn of the right cochlea. Hearing gradually deteriorated with complete hearing loss in 2015. At this time, an MRI scan showed a lesion completely filling the cochlea.The tumor was removed via transmeatal subtotal cochleoectomy. The cochlea was partially reconstructed with cartilage and fascia. A cochlea implant dummy electrode was inserted as a placeholder in order to prevent complete fibrosis of the "neocochlea" during follow-up MRI examinations.Vestibular function tests 2 months postoperatively showed preserved caloric excitability and a normal vestibulo-ocular reflex (vHIT) in all three planes. The patient is free of vertigo.Intralabyrinthine schwannomas (ILS) are a rare differential diagnosis of sudden hearing loss, which should be specifically checked for in MRI. Surgical removal of an intracochlear ILS through partial or subtotal cochleoectomy with preservation of vestibular function is possible in principle.
我们报告了一例患者,该患者于2005年,37岁时,右耳突然出现轻至中度的中频感音神经性听力损失,伴有耳鸣和轻度头晕。颞骨MRI显示右耳蜗第二转有一个非常小(1毫米)的强化病变。听力逐渐恶化,到2015年完全丧失听力。此时,MRI扫描显示病变完全充满耳蜗。通过经耳道部分耳蜗切除术切除肿瘤。耳蜗用软骨和筋膜进行了部分重建。插入了一个耳蜗植入物假电极作为占位符,以防止在后续MRI检查期间“新耳蜗”完全纤维化。术后2个月的前庭功能测试显示所有三个平面的冷热试验兴奋性保留且前庭眼反射(vHIT)正常。患者无眩晕。迷路内神经鞘瘤(ILS)是突发性听力损失的一种罕见鉴别诊断,在MRI中应进行专门检查。原则上,通过部分或次全耳蜗切除术并保留前庭功能来手术切除耳蜗内ILS是可行的。