在进一步听力恶化发生之前，接受立体定向放射外科手术的前庭神经鞘瘤患者听力保护效果更佳。
Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues.
机构信息
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Suite B-400, UPMC, Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
出版信息
J Neurooncol. 2021 May;152(3):559-566. doi: 10.1007/s11060-021-03726-6. Epub 2021 Mar 17.
INTRODUCTION
The present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.
METHODS
We retrospectively analyzed 1447 VS patients who underwent SRS between 1992 and 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.
RESULTS
The serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (< 55 years, p = 0.045) and HM during observation (p = 0.001) improved serviceable hearing preservation rates. Patients whose PTA increased ≥ 15 dB (p = 0.024) or whose SDS declined ≥ 10% (p = 0.019) had reduced serviceable hearing preservation rates.
CONCLUSIONS
Hearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.
介绍
本研究评估了在具有有用听力的前庭神经鞘瘤（VS）患者中，观察期间听力恶化是否会降低立体定向放射外科（SRS）后的可利用听力保留率。
方法
我们回顾性分析了 1992 年至 2017 年间接受 SRS 的 1447 例 VS 患者。我们确定了 100 例初始诊断时具有 I 级 Gardner-Robertson（GR）听力但未经手术或 SRS 观察的 VS 患者。我们比较了 67 例从初始诊断到 SRS 一直保留 GR I 级听力的患者（听力维持或 HM 组）与 33 例听力从 GR I 级恶化到 II 级的患者（听力恶化或 HD 组）的 SRS 后听力。我们还研究了 SRS 前纯音平均（PTA）或言语辨别率（SDS）下降是否影响 SRS 后的听力保留。
结果
HM 患者的可利用听力（GR I 和 II）保留率分别为 3 年、5 年和 10 年时的 80%、63%和 51%。HD 患者的可利用听力保留率分别为 3 年、5 年和 10 年时的 40%、33%和 20%。多变量分析显示，年龄较小（<55 岁，p=0.045）和观察期间的 HM（p=0.001）改善了可利用听力保留率。PTA 增加≥15dB（p=0.024）或 SDS 下降≥10%（p=0.019）的患者，可利用听力保留率降低。
结论
在 SRS 前观察期间听力恶化降低了初始诊断时具有 GR I 级听力的 VS 患者的长期听力保留率。建议在听力恶化前进行 SRS 以保留听力。
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