Department of Neurosciences, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.
the Instituto de Otología García-Ibáñez, Barcelona, Spain.
Laryngoscope. 2019 Oct;129(10):2378-2383. doi: 10.1002/lary.27805. Epub 2019 Jan 8.
The management of small- to medium-size (< 20 mm) sporadic vestibular schwannomas (VSs) continues to inspire debate. Preoperative pure tone thresholds and tumor size are recognized prognostic features of hearing preservation after surgery.
To investigate what preoperative characteristics were associated with nonserviceable hearing after surgery for VSs.
We retrospectively reviewed the audiological results of 92 patients treated with the middle cranial fossa (MCF) approach for resection of VSs (< 20 mm). Sex, age, symptoms, tumor site, tumor size, growth rate, and hearing class according to American Academy of Otolaryngology-Head and Neck Surgery guidelines were evaluated. Negative outcome was progression after surgery to nonserviceable hearing according to Gardner-Robertson classification. We included only patients with preoperative serviceable hearing.
After surgery, 48 patients (52.2%) had nonserviceable hearing. At univariate analysis, sex age, symptoms, tumor site, and size were not associated to hearing outcome. Tumor growth rate ≥ 2.16 mm/year (P = 0.02, odds ratio 8.5) and preoperative hearing class B (P = 0.03, OR 5.89) were statistically associated to nonserviceable hearing after VSs resection. Tumor growth rate ≥ 2.16 mm/year was also significantly associated to preoperative hearing class B (P = 0.01). At multivariate analysis, the only independent prognostic factor of progression to nonserviceable hearing in operated VSs was tumor growth rate ≥ 2.16 mm/year (P = 0.01, OR = 4.15).
We found a new prognostic indicator of hearing preservation after VS surgery with the MCF approach: the tumor growth rate. This feature should be further investigated before being considered in the decision-making process of VS treatment.
4 Laryngoscope, 129:2378-2383, 2019.
对于小至中型（<20 毫米）散发性前庭神经鞘瘤（VSs）的治疗仍存在争议。术前纯音听阈和肿瘤大小是手术保留听力的公认预后特征。
探讨影响 VS 手术患者术后听力不良的术前特征。
我们回顾性分析了 92 例行中颅窝（MCF）入路切除 VSs（<20 毫米）患者的听力结果。评估了性别、年龄、症状、肿瘤部位、肿瘤大小、生长速度和美国耳鼻喉科学院-头颈外科学会指南的听力分级。根据 Gardner-Robertson 分级，术后听力恶化至无法使用的听力为不良预后。我们仅纳入术前听力可使用的患者。
手术后，48 例（52.2%）患者听力不良。单因素分析显示，性别、年龄、症状、肿瘤部位和大小与听力结果无关。肿瘤生长速度≥2.16 毫米/年（P=0.02，优势比 8.5）和术前听力分级 B（P=0.03，OR 5.89）与 VS 切除后听力不良有统计学相关性。肿瘤生长速度≥2.16 毫米/年也与术前听力分级 B 显著相关（P=0.01）。多因素分析显示，肿瘤生长速度≥2.16 毫米/年是手术治疗 VS 后听力恶化的唯一独立预后因素（P=0.01，OR=4.15）。
我们发现了一种 MCF 入路治疗 VS 后听力保留的新预后指标：肿瘤生长速度。在考虑 VS 治疗决策时，应进一步研究该特征。
4 级，Laryngoscope，129：2378-2383，2019.
