Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital.
Ear Institute, Shanghai Jiaotong University School of Medicine.
Otol Neurotol. 2019 Aug;40(7):957-964. doi: 10.1097/MAO.0000000000002284.
The authors evaluated the long-term hearing outcomes of patients with vestibular schwannoma (VS) to explore appropriate surgical treatment.
Retrospective study.
Tertiary referral center.
A total of 138 patients diagnosed with small and medium-sized VS with serviceable hearing from January 2006 to December 2015.
All patients underwent microsurgery via retrosigmoid (RSA) or middle cranial fossa approach (MFA) and were followed up for over 2 years.
Pre- and postoperative hearing, including pure tone audiometry, speech discrimination score, and auditory brainstem response (ABR), were analyzed.
The mean tumor size and volume were 16.6 ± 3.4 mm and 1711.8 ± 918.5 mm, respectively. Preoperative hearing levels were Class A in 42, Class B in 67, and Class C in 29 patients. Patients with a tumor from the superior vestibular nerve (SVN) had better hearing at diagnosis. Postoperative hearing levels were Class A, B, C, and D for 28, 17, 32, and 61 patients. Hearing outcomes were significantly better in patients with normal intraoperative I wave on ABR. Hearing loss within 6 months had a positive effect on postoperative hearing. Better preoperative hearing and tumors from SVN were correlated with better postoperative hearing outcomes. Tumor size, cystic variation, or extension to the fundus of internal auditory canal had no influence on hearing preservation.
Better preoperative hearing, shorter hearing loss period, tumors from SVN, and normal intraoperative I wave are prognostic factors for serviceable hearing. RSA and MFA are effective and safe for tumor removal and hearing preservation.
评估前庭神经鞘瘤（VS）患者的长期听力结果，以探讨合适的手术治疗方法。
回顾性研究。
三级转诊中心。
2006 年 1 月至 2015 年 12 月期间共 138 例诊断为小-中型 VS 且具有可利用听力的患者。
所有患者均通过乙状窦后（RSA）或中颅窝入路（MFA）接受显微镜手术，并随访超过 2 年。
术前和术后听力，包括纯音听阈、言语辨别率和听性脑干反应（ABR）。
肿瘤的平均大小和体积分别为 16.6 ± 3.4mm 和 1711.8 ± 918.5mm。术前听力水平为 A 级的患者有 42 例，B 级的有 67 例，C 级的有 29 例。起源于上前庭神经（SVN）的肿瘤患者在诊断时听力更好。术后听力水平为 A、B、C 和 D 级的患者分别有 28、17、32 和 61 例。术中 ABR 中 I 波正常的患者听力改善更显著。术后 6 个月内听力损失对术后听力有积极影响。术前听力较好和肿瘤起源于 SVN 与术后听力结果较好相关。肿瘤大小、囊性变或延伸至内听道底部均对听力保护无影响。
更好的术前听力、较短的听力丧失时间、起源于 SVN 的肿瘤和术中 I 波正常是可利用听力的预后因素。RSA 和 MFA 是肿瘤切除和听力保护的有效且安全的方法。
