Foley Robert W, Shirazi Shahram, Maweni Robert M, Walsh Kay, McConn Walsh Rory, Javadpour Mohsen, Rawluk Daniel
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals, United Kingdom.
School of Medicine, University College Dublin.
Cureus. 2017 Nov 15;9(11):e1846. doi: 10.7759/cureus.1846.
Introduction The objective of this study was to describe the most common clinical features associated with an acoustic neuroma diagnosis and to identify those features associated with larger tumour size at initial diagnosis. Methods The clinical information of 945 consecutive patients diagnosed with acoustic neuroma at a single centre between 1992 and 2015 was analysed. Clinical features were examined and the relationship between these features and tumour size (>2.5 cm) was analysed using descriptive statistics and logistic regression analysis. Statistical analysis was performed in R version 3.1.1. Results The most common presenting symptom was a unilateral hearing loss in 752 patients (80%), with a progressive pattern in 90% of these cases. The second most common presenting symptom was unilateral tinnitus, accounting for 6.3%, while ataxia, vertigo and headache accounted for 3.8%, 3.4% and 2%, respectively. The diagnosis of acoustic neuroma was an incidental finding in 20 patients (2.1%). Temporal analysis demonstrated a downward trend in the number of patients presenting with hearing loss and an increased proportion of patients presenting with other symptoms. On multivariate analysis, larger tumour size was associated with abnormal tandem gait (odds ratio 8.9, p=0.02), subjective facial weakness (odds ratio 5.3, p< 0.001), abnormal facial sensation on examination (odds ratio 3.0, p=0.03) and headache (odds ratio 2.6, p< 0.001). Conclusion The majority of patients with acoustic neuroma present with the classic, progressive, unilateral hearing loss. However, the pattern of presentation in acoustic neuroma patients is changing. Features in the history indicative of a larger tumour are headaches and subjective facial weakness, whilst concerning features on examination are abnormal tandem gait and altered facial sensation.
引言 本研究的目的是描述与听神经瘤诊断相关的最常见临床特征，并确定那些在初次诊断时与较大肿瘤大小相关的特征。方法 分析了1992年至2015年间在单一中心连续诊断为听神经瘤的945例患者的临床信息。检查了临床特征，并使用描述性统计和逻辑回归分析来分析这些特征与肿瘤大小（>2.5 cm）之间的关系。使用R 3.1.1版本进行统计分析。结果 最常见的首发症状是752例患者（80%）出现单侧听力丧失，其中90%的病例呈进行性。第二常见的首发症状是单侧耳鸣，占6.3%，而共济失调、眩晕和头痛分别占3.8%、3.4%和2%。听神经瘤的诊断在20例患者（2.1%）中为偶然发现。时间分析显示，出现听力丧失的患者数量呈下降趋势，而出现其他症状的患者比例有所增加。多因素分析显示，较大的肿瘤大小与异常串联步态（比值比8.9，p=0.02）、主观面部无力（比值比5.3，p<0.001）、检查时面部感觉异常（比值比3.0，p=0.03）和头痛（比值比2.6，p<0.001）相关。结论 大多数听神经瘤患者表现为典型的、进行性的单侧听力丧失。然而，听神经瘤患者的表现模式正在发生变化。病史中提示较大肿瘤的特征是头痛和主观面部无力，而检查中相关的特征是异常串联步态和面部感觉改变。
