Huang Yen-Chieh, Hsu Sanford P C, Chiang Kuan-Wei, Wang Mao-Che
Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Audiol Neurootol. 2023;28(1):63-74. doi: 10.1159/000524820. Epub 2022 Sep 8.
The aim of this study was to better understand the onset time and factors associated with cochlear obliteration following translabyrinthine approach (TLA) surgery for large cerebellopontine angle tumors.
This retrospective cohort study included 117 patients with large cerebellopontine angle tumor (tumor diameter >2 cm) treated by TLA surgery from June 2011 to March 2019 in a single tertiary referral center. The Kaplan-Meier method with log-rank test was used to estimate cochlear patency survival and the association between survival and covariates, and the Cox proportional hazards regression analysis was used to identify possible factors associated with cochlear obliteration.
Of the 117 patients included in our analysis, the median follow-up was 24.8 months. There were 30 (25.6%) patients in the cochlear obliteration group, and 87 (74.4%) in the patent cochlear group. Various degrees of cochlear obliteration was found in 25.6% patients in final MRI scan, comprised of 50% grade I, 30% grade II, and 20% grade III. Cochlear patency survival curves showed 94.0% at 3 months, 73.0% at 18 months, which plateaued after 20 months with a survival rate of 71.6%. In the multivariate Cox proportional hazards model, patients presented with postoperative hyperintense T1W cochlear signal had poorer cochlear patency survival compared to isointense T1W (HR = 4.15). Similarly, postoperative deteriorated facial function (HR = 4.52) and full IAC involvement of tumor (HR = 2.33) demonstrated a higher risks of cochlear obliteration after TLA surgery.
The 2-year estimated cochlear patency rate was 71.6% in patients that received TLA. Cochlear obliteration can develop as early as 3 months post-surgery, with no new obliteration 20 months after the surgery and half of these patients got severe obliteration. Three factors associated with cochlear obliteration were identified including full IAC involvement of tumor, postoperative facial function deterioration, and postoperative hyperintense T1W cochlear signal.
本研究旨在更好地了解经迷路入路（TLA）手术治疗大型桥小脑角肿瘤后耳蜗闭塞的发病时间及相关因素。
本回顾性队列研究纳入了2011年6月至2019年3月在一家三级转诊中心接受TLA手术治疗的117例大型桥小脑角肿瘤患者（肿瘤直径>2 cm）。采用Kaplan-Meier法和对数秩检验来估计耳蜗通畅生存率以及生存率与协变量之间的关联，并使用Cox比例风险回归分析来确定与耳蜗闭塞相关的可能因素。
在我们分析的117例患者中，中位随访时间为24.8个月。耳蜗闭塞组有30例（25.6%）患者，耳蜗通畅组有87例（74.4%）患者。在最终的MRI扫描中，25.6%的患者出现了不同程度的耳蜗闭塞，其中I级占50%，II级占30%，III级占20%。耳蜗通畅生存曲线显示，3个月时为94.0%，18个月时为73.0%，20个月后趋于平稳，生存率为71.6%。在多变量Cox比例风险模型中，术后耳蜗T1加权像信号高强化的患者与等信号患者相比，耳蜗通畅生存率较差（风险比=4.15）。同样，术后面神经功能恶化（风险比=4.52）和肿瘤完全累及内听道（风险比=2.33）表明TLA手术后耳蜗闭塞的风险较高。
接受TLA手术的患者2年估计耳蜗通畅率为71.6%。耳蜗闭塞最早可在术后3个月出现，术后20个月无新的闭塞发生，且这些患者中有一半出现严重闭塞。确定了与耳蜗闭塞相关的三个因素，包括肿瘤完全累及内听道、术后面神经功能恶化和术后耳蜗T1加权像信号高强化。
