Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
Oper Neurosurg (Hagerstown). 2019 Feb 1;16(2):147-158. doi: 10.1093/ons/opy126.
The middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP).
To describe a decade-long, single institutional experience with the MCF approach for resection of VS.
This is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House-Brackmann scale.
The mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation.
In our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.
中颅窝（MCF）入路是切除小及中等大小、主要位于管内的前庭神经鞘瘤（VS）的一种具有挑战性的手术技术，其目标是保留听力（HP）。
描述 MCF 入路切除 VS 的长达十年的单机构经验。
这是一项回顾性队列研究，纳入了 2006 年至 2016 年间接受 MCF 入路切除 VS 的 63 例患者。听力数据包括纯音平均听阈（PTA）、低频纯音平均听阈（LtPTA）、言语识别得分和美国耳鼻喉科学院-头颈外科学会（AAO-HNS）听力分类，包括术前和随访时的分类。将术后具有可服务（AAO-HNS 分级 A-B）和/或有用（AAO-HNS 分级 A-C）听力的患者与无听力保留（HP）的患者进行比较。面神经功能采用 House-Brackmann 量表进行评估。
患者的平均年龄和随访时间分别为 50±13 岁和 21±21 个月。肿瘤平均大小为 10±4mm。可服务和有用的 HP 率分别为 54%和 50%。71%的患者保留了一定的残余听力。较大的肿瘤大小（P=0.05）、体积（P=0.03）和外听道外肿瘤延伸（P=0.03）与较差的听力结果相关。存在颅底液帽（P=0.01）是一个有利的发现。在最终测试中，LtPTA 明显优于传统 PTA（P=0.01）。面神经功能结果、肿瘤控制率和听力结果的持久性均非常出色。47%的患者接受了听觉康复。
在我们的系列研究中，MCF 入路治疗 VS 提供了极好的肿瘤和面神经功能保留率，具有持久的可服务性 HP。
