Rahne Torsten, Plontke Stefan K, Fröhlich Laura, Strauss Christian
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Universitäts-HNO-Klinik, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
Sci Rep. 2021 Apr 21;11(1):8608. doi: 10.1038/s41598-021-87515-1.
In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of - 0.32 for cVEMP and - 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.
在前庭神经鞘瘤（VS）患者中，听力结果和手术相关风险可能会有所不同，并取决于神经的起源。术前区分下前庭神经或上前庭神经的起源可能会影响治疗决策、最佳治疗方法的选择以及咨询方式。设计了一种基于功能测试的新型评分系统来预测VS的神经起源，并将其应用于大量连续患者。在一家三级转诊中心进行了一项前瞻性、双盲队列研究，纳入93例疑似单侧VS患者。在肿瘤切除术前，进行了一系列功能测试，包括所有半规管（SCC）的视频头脉冲测试（vHIT）、气导颈/眼前庭诱发肌源性电位测试（cVEMP、oVEMP）、纯音听力测定和言语辨别测试。计算了基于vHIT增益、cVEMP和oVEMP振幅及不对称率的术前评分对术中发现预测的敏感性和特异性。对于下前庭神经起源的预测，敏感性为73%，特异性为80%。对于上前庭神经起源的预测，敏感性为60%，特异性为90%。根据敏感性和特异性之间的权衡，通过受试者操作特征曲线确定了cVEMP不对称率的优化截断值为-0.32，oVEMP不对称率的优化截断值为-0.11，以及vHIT增益阈值分别为0.77（前半规管）、0.84（外半规管）和0.80（后半规管）。基于术前功能测试的评分系统提高了神经起源的预测能力，可应用于临床常规。
