Marchioni Daniele, De Rossi Stefano, Soloperto Davide, Presutti Livio, Sacchetto Luca, Rubini Alessia
Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, via del Pozzo, 71, 41124, Modena, Italy.
Eur Arch Otorhinolaryngol. 2018 May;275(5):1095-1102. doi: 10.1007/s00405-018-4937-0. Epub 2018 Mar 20.
To define a new surgical option, with lower morbidity, for the treatment of intralabyrinthine schwannomas.
Retrospective case review.
Tertiary referral centers.
Eight patients affected by an intralabyrinthine schwannoma, with or without extension to the internal auditory canal, that underwent surgery with a transcanal transpromontorial approach, were included in the study. The average age at presentation was 47 years. Patients' characteristics, symptoms, tumor features, and surgical results were analyzed.
All patients were diagnosed and evaluated pre-operatively with high-resolution, gadolinium-enhanced MRI and CT scan of the temporal bone, and underwent surgery via either transcanal transpromontorial endoscopic approach (TTEA) or enlarged transcanal transpromontorial endoscopic approach (ETTA).
Hearing function was evaluated with the Hearing Classification System according to the Committee on Hearing and Equilibrium Guidelines. Facial nerve function was evaluated using the House-Brackmann grading system (HB).
In six patients out of eight, a TTEA was performed, whereas, due to the extension of the pathology to the cerebellopontine angle, two patients underwent an ETTA. The mean follow-up period was 15.5 months (range 1-69). No intra-operative and post-operative major complications were observed. Post-operative facial nerve function was normal in seven out of eight patients (grade I HB). One patient presented a grade II HB.
The endoscopic approach to cochlear schwannoma represents a good treatment option for patients and should be preferred to other more invasive surgical techniques when indicated, to reduce complications, hospitalization, and offer to patients the chance to eradicate the disease, thus avoiding the stress of a long-life radiological follow-up.
定义一种新的手术方式，用于治疗迷路内神经鞘瘤，降低发病率。
回顾性病例分析。
三级转诊中心。
8例迷路内神经鞘瘤患者，肿瘤有无向内听道延伸，均采用经耳道经鼓岬入路进行手术，纳入本研究。患者就诊时的平均年龄为47岁。分析患者的特征、症状、肿瘤特点及手术结果。
所有患者术前均采用高分辨率钆增强磁共振成像（MRI）和颞骨CT扫描进行诊断和评估，并通过经耳道经鼓岬内镜入路（TTEA）或扩大经耳道经鼓岬内镜入路（ETTA）进行手术。
根据听力与平衡委员会指南，采用听力分类系统评估听力功能。采用House-Brackmann分级系统（HB）评估面神经功能。
8例患者中，6例行TTEA，2例因病变延伸至桥小脑角而行ETTA。平均随访时间为15.5个月（范围1 - 69个月）。未观察到术中及术后严重并发症。8例患者中有7例术后面神经功能正常（HB分级I级）。1例患者为HB分级II级。
内镜治疗耳蜗神经鞘瘤对患者来说是一种很好的治疗选择，在有指征时应优先于其他侵入性更强的手术技术，以减少并发症、缩短住院时间，并为患者提供根除疾病的机会，从而避免长期影像学随访带来的压力。
4级。
