Ren Yin, Tawfik Kareem O, Mastrodimos Bill J, Cueva Roberto A
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, San Diego, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Otolaryngol Head Neck Surg. 2021 Aug;165(2):344-353. doi: 10.1177/0194599820978246. Epub 2020 Dec 8.
To identify preoperative radiographic predictors of hearing preservation (HP) after retrosigmoid resection of vestibular schwannomas (VSs).
Retrospective case series with chart review.
Tertiary skull base referral center.
Adult patients with VSs <3 cm and word recognition scores (WRSs) ≥50% who underwent retrosigmoid resection and attempted HP between February 2008 and December 2018 were identified. Pure tone average (PTA), WRS, and magnetic resonance imaging radiographic data, including tumor diameter and dimensional extension relative to the internal auditory canal (IAC), were examined.
A total of 151 patients were included. The average tumor size was 13.8 mm (range, 3-28). Hearing was preserved in 41.7% (n = 63). HP rates were higher for intracanalicular tumors than tumors with cerebellopontine angle (CPA) components (57.6% vs 29.4%, = .03). On multivariate analysis, maximal tumor diameter (odds ratio [OR], 0.892; .001) and preoperative PTA (OR, 0.974; = .026) predicted HP, while mediolateral tumor diameter predicted postoperative PTA (OR, 1.21; = .005) and WRS (OR, -1.89; < .001). For tumors extending into the CPA, younger age (OR, 0.913; = .012), better preoperative PTA (OR, 0.935; = .049), smaller posterior tumor extension (OR, 0.862; = .001), and smaller caudal extension relative to the IAC (OR, 0.844; = .001) all predicted HP.
Rates of HP are highest in patients with small intracanalicular VSs and good preoperative hearing. For tumors extending into the CPA, greater posterior and caudal tumor extension relative to the IAC may portend worse hearing outcomes.
确定乙状窦后入路切除前庭神经鞘瘤（VS）后听力保留（HP）的术前影像学预测指标。
回顾性病例系列研究并查阅病历。
三级颅底转诊中心。
纳入2008年2月至2018年12月期间接受乙状窦后入路切除且尝试保留听力、VS直径<3 cm且言语识别率（WRS）≥50%的成年患者。检查纯音平均听阈（PTA）、WRS以及磁共振成像影像学数据，包括肿瘤直径和相对于内耳道（IAC）的维度延伸情况。
共纳入151例患者。平均肿瘤大小为13.8 mm（范围3 - 28 mm）。41.7%（n = 63）的患者听力得以保留。内听道内肿瘤的听力保留率高于伴有小脑脑桥角（CPA）成分的肿瘤（57.6%对29.4%，P = .03）。多因素分析显示，肿瘤最大直径（比值比[OR]，0.892；P < .001）和术前PTA（OR，0.974；P = .026）可预测听力保留，而肿瘤的内外侧直径可预测术后PTA（OR，1.21；P = .005）和WRS（OR， - 1.89；P < .001）。对于延伸至CPA的肿瘤，年龄较小（OR，0.91；P = .012）、术前PTA较好（OR，0.935；P = .049）、肿瘤后向延伸较小（OR，0.862；P = .001）以及相对于IAC的尾端延伸较小（OR，0.844；P = .001）均提示听力保留。
内听道内小VS且术前听力良好患者的听力保留率最高。对于延伸至CPA 的肿瘤，相对于IAC更大的后向和尾端肿瘤延伸可能预示更差的听力结果。
