Department of Neurosurgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan.
Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
Acta Neurochir (Wien). 2020 Nov;162(11):2619-2628. doi: 10.1007/s00701-020-04523-2. Epub 2020 Aug 15.
In patients with a vestibular schwannoma, some studies have reported that useful hearing preserved initially after surgery deteriorates gradually in the long term. Studies with more patients are needed to clarify the maintenance rate of postoperative hearing function and to identify prognostic of hearing function.
Ninety-one patients (mean age, 39.5 years; mean tumor size, 18.9 mm) with preserved useful hearing immediately after surgery were retrospectively analyzed. The useful hearing was defined as the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classes A and B. Hearing tests, including auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE), were evaluated preoperatively, immediately after surgery, and at outpatient follow-up.
At the final follow-up (mean, 63.0 months), the useful hearing was maintained in 79 patients (87%), and the hearing class remained unchanged during the follow-up period in 40 patients (44%). Significant predictors of useful hearing maintenance were AAO-HNS class A immediately after surgery, improvement of ABR, and the absence of postoperative DPOAE deterioration. Postoperative DPOAE deterioration correlated with hearing class deterioration.
Despite hearing being preserved in vestibular schwannoma patients immediately after surgery, Thirteen percent lost their useful hearing during the long follow-up period, and hearing class worsened in 55% of the patients. This study, which analyzed one of the largest series of vestibular schwannoma patients, demonstrated that retrocochlear condition is a key factor for useful hearing maintenance. In patients with vestibular schwannoma who have preserved hearing function, regular postoperative monitoring of hearing function is as important as regular MRI.
一些研究报告称，在接受前庭神经鞘瘤手术的患者中，一些患者在手术后最初保留的有用听力会逐渐恶化。需要更多的研究来阐明术后听力功能的维持率，并确定听力功能的预后。
回顾性分析了 91 例（平均年龄 39.5 岁，平均肿瘤大小 18.9mm）术后即刻保留有用听力的患者。有用听力定义为美国耳鼻喉科学会-头颈外科学会（AAO-HNS）A 级和 B 级。术前、术后即刻及门诊随访时进行听力测试，包括听性脑干反应（ABR）和畸变产物耳声发射（DPOAE）。
末次随访（平均 63.0 个月）时，79 例（87%）患者有用听力保留，40 例（44%）患者听力分级在随访期间保持不变。有用听力保留的显著预测因素包括术后即刻 AAO-HNS 分级 A、ABR 改善和术后 DPOAE 无恶化。术后 DPOAE 恶化与听力分级恶化相关。
尽管前庭神经鞘瘤患者术后即刻听力保留，但在长期随访中，仍有 13%的患者失去有用听力，55%的患者听力分级恶化。本研究分析了最大的前庭神经鞘瘤患者系列之一，表明耳蜗后状况是有用听力维持的关键因素。对于保留听力功能的前庭神经鞘瘤患者，定期监测听力功能与定期 MRI 检查同样重要。
