连续8例患者经乙状窦后入路行前庭神经鞘瘤清醒手术后听力的保留情况。
Preservation of hearing following awake surgery via the retrosigmoid approach for vestibular schwannomas in eight consecutive patients.
作者信息
Shinoura Nobusada, Midorikawa Akira, Hiromitsu Kentaro, Saito Shoko, Yamada Ryoji
机构信息
Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Psychology, Faculty of Letters, Chuo University, 742-1 Higashi-nakano, Hachioji City, Tokyo, 192-0393, Japan.
出版信息
Acta Neurochir (Wien). 2017 Sep;159(9):1579-1585. doi: 10.1007/s00701-017-3235-8. Epub 2017 Jul 3.
BACKGROUND
Hearing preservation in patients with vestibular schwannomas remains difficult by microsurgery or radiosurgery.
METHOD
In this study, awake surgery via the retrosigmoid approach was performed for vestibular schwannomas (volume, 11.6 ± 11.2 ml; range, 1.3-26.4 ml) in eight consecutive patients with preoperative quartering of pure tone audiometry (PTA) of 53 ± 27 dB.
RESULTS
After surgery, hearing was preserved in seven patients and improved in one patient. The postoperative quartering PTA was 51 ± 21 dB. Serviceable hearing (class A + B + C) using the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification was preserved in all patients. Preoperative useful hearing (AAO-HNS class A + B) was observed in three patients, and useful hearing was preserved in all three of these patients after surgery. In addition, useful facial nerve function (House-Blackmann Grade 1) was preserved in all patients.
CONCLUSIONS
These results suggest that awake surgery for vestibular schwannomas is associated with low patient morbidity, including with respect to hearing and facial nerve function.
背景
对于前庭神经鞘瘤患者，通过显微手术或放射外科手术保留听力仍然困难。
方法
在本研究中，对连续8例术前纯音听力测定（PTA）四分区为53±27dB的前庭神经鞘瘤患者（体积为11.6±11.2ml；范围为1.3 - 26.4ml）采用乙状窦后入路进行清醒手术。
结果
术后，7例患者听力得以保留，1例患者听力改善。术后PTA四分区为51±21dB。所有患者均保留了采用美国耳鼻咽喉头颈外科学会（AAO - HNS）分类的有效听力（A + B + C级）。术前有3例患者存在有用听力（AAO - HNS A + B级），术后这3例患者的有用听力均得以保留。此外，所有患者均保留了有用的面神经功能（House - Blackmann 1级）。
结论
这些结果表明，前庭神经鞘瘤的清醒手术与低患者发病率相关，包括听力和面神经功能方面。
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