Department of Otolaryngology Head and Neck Surgery.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Otol Neurotol. 2021 Feb 1;42(2):306-311. doi: 10.1097/MAO.0000000000002923.
Management of small vestibular schwannomas has evolved to where observation with interval imaging is an accepted treatment strategy. Loss of residual hearing is a known complication of observation. Magnetic resonance imaging (MRI) may provide critical information to assist in determining which tumors are at highest risk of hearing loss. We wished to determine what effect fundal cap size and cochlear fluid-attenuated inversion recovery (FLAIR) signal had on the progression of hearing loss in a large cohort of observed subjects.
Retrospective chart review.
Tertiary academic referral center.
Three hundred ninety-three adults with a vestibular schwannoma who underwent expectant management with serial audiograms and MRI.
Audiogram and MRI.
Hearing outcomes included pure-tone average and word discrimination score (WRS). Cochlear FLAIR signal was measured as a ratio between the affected and nonaffected cochlea. Cerebrospinal fluid fundal cap was measured from the most lateral aspect of the tumor to the fundus of the internal auditory canal.
An increased cochlear FLAIR ratio was associated with a worse initial WRS (p = 0.0001, β=-0.25). A multivariate regression analysis demonstrated the variables fundal cap and initial WRS to significantly predict change in WRS over time. The larger the fundal cap size, the smaller the change in the WRS (p = 0.047, β=-0.35).
Cerebrospinal fluid fundal cap size predicts the natural history of hearing in vestibular schwannoma patients. The presence of a smaller fundal cap is correlated with a greater risk of progression of hearing loss and should be a variable considered in the management of small vestibular schwannomas.
小型前庭神经鞘瘤的管理已经发展到观察并定期进行影像学检查的治疗策略已被广泛接受。听力保留是观察的已知并发症。磁共振成像（MRI）可能提供关键信息，以帮助确定哪些肿瘤具有听力损失的最高风险。我们希望确定基底池大小和耳蜗液体衰减反转恢复（FLAIR）信号对观察队列中大量受试者听力损失进展的影响。
回顾性图表审查。
三级学术转诊中心。
393 名成年人，患有前庭神经鞘瘤，他们接受了期待性管理，包括连续听力图和 MRI。
听力图和 MRI。
听力结果包括纯音平均听阈和言语辨别得分（WRS）。耳蜗 FLAIR 信号的测量方法是受影响和未受影响耳蜗之间的比值。脑脊液基底池从肿瘤最外侧到内听道基底测量。
耳蜗 FLAIR 比值增加与初始 WRS 较差相关（p = 0.0001，β =-0.25）。多变量回归分析表明，基底池和初始 WRS 这两个变量显著预测了 WRS 随时间的变化。基底池越大，WRS 的变化越小（p = 0.047，β =-0.35）。
脑脊液基底池大小预测了前庭神经鞘瘤患者听力的自然史。较小的基底池与听力损失进展的风险增加相关，应作为小型前庭神经鞘瘤管理中的一个变量考虑。
