Sykopetrites Vittoria, Piras Gianluca, Taibah Abdelkader, Sanna Mario
Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
Laryngoscope. 2021 Feb;131(2):E413-E419. doi: 10.1002/lary.28987. Epub 2020 Aug 18.
Identify and define specific preoperative and postoperative characteristics of intracanalicular meningiomas (ICMs) in order to improve their diagnosis and management, and to differentiate them from intrameatal vestibular schwannomas (IMVSs).
Preoperative symptomatology, magnetic resonance imaging (MRI), and postoperative outcomes of 28 ICMs were analyzed. The results were compared to the literature and IMVSs treated by our group.
Anacusis and progressive hearing loss were more frequent in the present population than the cases reviewed (P = .0064 and P = .0001, respectively). Hearing loss affected more than 90% of the patients, with anacusis in 32.1% of the cases. Facial palsy affected 17.9% of the patients. In comparison to IMVSs, preoperative anacusis was more associated to meningiomas (P = .0037), and the facial nerve was more compromised in ICMs than IMVSs, both preoperatively (P = .0011) and at follow-up (P < .0001). According to a re-evaluation of preoperative MRIs and comparison with IMVSs, linear tumor borders, and linear morphology along the internal auditory canal wall, but not the presence of a dural tail, were significantly more present in ICMs (P = .0035, P = .0004, P = .1963, respectively). These characteristics could have led to a correct preoperative diagnosis in 61% of our cases.
Contrariwise to IMVSs, the frequent preoperative anacusis and facial palsy demonstrate the more aggressive nature of ICMs, which also carry a higher risk of postoperative facial palsy and difficulty to preserve hearing. An attentive evaluation of imaging should ease diagnosis, and asymptomatic or stable ICMs should be enrolled in a wait-and-scan protocol.
4 Laryngoscope, 131:E413-E419, 2021.
识别并定义管内型脑膜瘤（ICM）的术前和术后特定特征，以改善其诊断和管理，并将其与内耳道前庭神经鞘瘤（IMVS）进行区分。
分析28例ICM的术前症状、磁共振成像（MRI）及术后结果。将结果与文献及本团队治疗的IMVS进行比较。
与文献报道的病例相比，本研究人群中失聪和渐进性听力损失更为常见（分别为P = 0.0064和P = 0.0001）。听力损失影响了超过90%的患者，32.1%的病例出现失聪。面神经麻痹影响了17.9%的患者。与IMVS相比，术前失聪与脑膜瘤的相关性更强（P = 0.0037），ICM中面神经在术前（P = 0.0011）及随访时（P < 0.0001）比IMVS受到的损害更大。根据对术前MRI的重新评估并与IMVS比较，ICM中线性肿瘤边界以及沿内耳道壁的线性形态更为显著，但脑膜尾征的出现情况并非如此（分别为P = 0.0035、P = 0.0004、P = 0.1963）。这些特征在61%的病例中可实现术前正确诊断。
与IMVS相反，ICM术前频繁出现失聪和面神经麻痹表明其具有更强的侵袭性，术后面神经麻痹风险更高且听力保留困难。仔细评估影像学有助于诊断，无症状或病情稳定的ICM应纳入观察和扫描方案。
4 《喉镜》，131:E413 - E419，2021年。
