Schaumann Katharina, Albrecht A, Turowski B, Hoffmann C, Cornelius J F, Schipper J
Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde und Poliklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland.
Institut für diagnostische und interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
HNO. 2022 Jun;70(6):445-454. doi: 10.1007/s00106-021-01116-y. Epub 2021 Nov 23.
The data of 86 patients with retrosigmoid microsurgical resection of vestibular schwannoma in tumor stage Koos II-IV were evaluated. In more than two thirds of the cases it was shown that the cochlear nerve followed the facial nerve, which is easily identified by electroneurography, in recurrent similar patterns in the region of the internal auditory canal. Starting from the fundus, this facilitated early identification and thus preservation of continuity of the cochlear nerve in the course of the internal auditory canal. This was of particular importance when safe functional preservation could not be guaranteed due to tumor size or formation despite intraoperative derivation of somatosenoric potentials, but when the possibility of subsequent hearing rehabilitation with a cochlear implant should be granted. Preoperative MRI sequences gave an indication of the possible nerve courses in some cases, but intraoperative imaging in the internal auditory canal was superior to MRI.
对86例处于库斯II-IV期的前庭神经鞘瘤患者进行乙状窦后显微手术切除的数据进行了评估。在超过三分之二的病例中发现，耳蜗神经与面神经走行一致，通过神经电图很容易识别，在内耳道区域呈现反复相似的模式。从内耳道底部开始，这有助于早期识别并因此在手术过程中保留耳蜗神经在内耳道内的连续性。当由于肿瘤大小或形态原因，尽管术中引出了躯体感觉电位，但仍无法保证安全的功能保留，但应考虑后续使用人工耳蜗进行听力康复时，这一点尤为重要。术前MRI序列在某些情况下可提示可能的神经走行，但内耳道的术中成像优于MRI。
