Ren Yin, Merna Catherine M, Tawfik Kareem O, Schwartz Marc S, Friedman Rick A
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, United States.
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, United States.
J Neurol Surg B Skull Base. 2021 Jan 21;83(5):496-504. doi: 10.1055/s-0040-1722718. eCollection 2022 Oct.
To analyze the relationship between preoperative and intraoperative auditory brain stem response (ABR) characteristics and hearing outcomes in patients with vestibular schwannomas (VS) undergoing hearing preservation (HP) surgery via a middle cranial fossa (MCF) approach. Prospective study. Academic tertiary skull base referral center. Pre- and postoperative pure-tone average (PTA) and word recognition score (WRS) were examined. Intraoperative ABR wave III latency, wave V latency, and amplitude were recorded. HP was defined as postoperative WRS ≥50%. Adult patients with VS and WRS ≥50% who underwent MCF tumor resection between November 2017 and September 2019. Postoperative hearing outcomes. Sixty patients were included. Mean tumor size was 9.2 mm (range, 3-17). HP rates were 56.7% for the cohort and 69.7% for tumors <10 mm. A complete loss of wave V was associated with an 82.9% increase in postoperative PTA ( < 0.001) and 97.2% decrease in WRS ( < 0.001), whereas a diminished wave V was correlated with 62.7% increase in PTA ( < 0.001) and 55.7% decrease in WRS ( = 0.006). A diminished or absent wave V, but not increased wave III/V latency or decreased wave V amplitude, was correlated with a decline in postoperative hearing class ( = 0.735, < 0.001). Receiver-operating characteristic analysis demonstrated that a stable wave V has the highest accuracy in predicting HP (sensitivity of 82.6%, specificity of 84.8%). Of the examined preoperative and intraoperative ABR characteristics, a stable wave V intraoperatively was the strongest predictor of HP after MCF resection of VS. Level III.
分析经中颅窝（MCF）入路行听力保留（HP）手术的前庭神经鞘瘤（VS）患者术前和术中听觉脑干反应（ABR）特征与听力结果之间的关系。前瞻性研究。学术性三级颅底转诊中心。检查术前和术后纯音平均听阈（PTA）和言语识别率（WRS）。记录术中ABR波III潜伏期、波V潜伏期和波幅。HP定义为术后WRS≥50%。2017年11月至2019年9月期间接受MCF肿瘤切除术的VS成年患者且WRS≥50%。术后听力结果。纳入60例患者。平均肿瘤大小为9.2mm（范围3 - 17mm）。该队列的HP率为56.7%，肿瘤<10mm者的HP率为69.7%。波V完全消失与术后PTA升高82.9%（<0.001）和WRS降低97.2%（<0.001）相关，而波V减弱与PTA升高62.7%（<0.001）和WRS降低55.7%（=0.006）相关。波V减弱或消失，但不是波III/V潜伏期延长或波V波幅降低，与术后听力分级下降相关（=0.735，<0.001）。受试者工作特征分析表明，稳定的波V在预测HP方面具有最高的准确性（敏感性为82.6%，特异性为84.8%）。在所检查的术前和术中ABR特征中，术中稳定的波V是VS经MCF切除术后HP的最强预测指标。III级。
