Department of Otorhinolaryngology Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol.
Department of Radiology, Na Homolce Hospital.
Otol Neurotol. 2023 Mar 1;44(3):260-265. doi: 10.1097/MAO.0000000000003801. Epub 2023 Jan 8.
Currently, it is possible to preserve the auditory nerve in a large number of cases, but the preservation of the hearing itself is unpredictable. Apart from wait and scan strategy and stereoradiotherapy, hearing after vestibular schwannoma surgery is considered to remain stable even in long-term follow-up.
Twenty-eight patients had preserved hearing after retrosigmoid suboccipital microsurgery of the vestibular schwannoma between 2008 and 2014. A standard audiological protocol was performed together with an magnetic resonance imaging evaluation of the fluid content of the inner ear.
The mean difference in pure-tone average between the direct and final postsurgical examination was 12.758 dB ( p = 2.5E - 06). The word recognition score deteriorated by 17.45% ( p = 0.03516). The mean American Academy of Otolaryngology-Head and Neck Surgery score on the second examination was 2.5, and that on the second examination was 3.111 ( p = 0.00483). There was no significant deterioration in the healthy ear.The signal intensity ratio in the basal turn of the cochlea increased by an average of 0.13 points ( p < 0.05).Patients with persistent tumor or nodular enhancement in the internal acoustic meatus deteriorated significantly in hearing according to the American Academy of Otolaryngology-Head and Neck Surgery scale compared with patients without any finding in the meatus ( p = 0.01299).
There is a discrete but gradual deterioration of the hearing in the postoperative period. Hearing impairment is more pronounced in patients with a nodular process in the internal acoustic meatus, regardless of whether it is growth active. After surgery, the pathological content of the inner ear normalizes (evaluated on T2 magnetic resonance imaging sequences).
目前，在大量情况下可以保留听神经，但听力本身的保留是不可预测的。除了等待和扫描策略以及立体放射治疗外，即使在长期随访中，前庭神经鞘瘤手术后的听力也被认为是稳定的。
2008 年至 2014 年间，有 28 例患者在经颅后下小脑窝显微手术切除前庭神经鞘瘤后保留了听力。我们一起进行了标准的听力学检查，并对内耳的液体含量进行了磁共振成像评估。
直接和最终术后检查的纯音平均差异为 12.758dB（p=2.5E-06）。单词识别分数恶化了 17.45%（p=0.03516）。第二次检查的平均美国耳鼻喉科学院-头颈外科学评分（Audiological Society of America-Head and Neck Surgery，AAS-HNS）为 2.5，第二次检查为 3.111（p=0.00483）。健耳无明显恶化。耳蜗底回的信号强度比平均增加了 0.13 分（p<0.05）。
内听道内持续存在肿瘤或结节强化的患者，根据美国耳鼻喉科学院-头颈外科学会（Audiological Society of America-Head and Neck Surgery，AAS-HNS）评分，听力明显恶化，与内听道无任何发现的患者相比（p=0.01299）。
术后听力有轻微但逐渐恶化。内听道内有结节状病变的患者听力损害更为明显，无论其生长是否活跃。手术后，内耳的病理内容物恢复正常（在 T2 磁共振成像序列上评估）。
