Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2023 Aug;169(2):333-339. doi: 10.1002/ohn.247. Epub 2023 Jan 29.
This study aims to investigate patterns of cochlear ossification (CO) in cadaveric temporal bones of patients who underwent vestibular schwannoma (VS) surgery via the translabyrinthine (TL), middle cranial fossa (MF), or retrosigmoid (RS) approaches.
Histopathologic analysis of cadaveric temporal bones.
Multi-institutional national temporal bone repository.
The National Institute of Deafness and Communication Disorders and House Temporal Bone Laboratory at the University of California, Los Angeles and the Massachusetts Eye and Ear Otopathology Laboratory were searched for cadaveric temporal bones with a history of VS for which microsurgery was performed. Exclusion criteria included non-VS and perioperative death within 30 days of surgery. Temporal bones were analyzed histologically for CO of the basal, middle, and apical turns.
Of 92 temporal bones with a history of schwannoma from both databases, 12 of these cases met the inclusion criteria. The approaches for tumor excision included 2 MF, 4 RS, and 6 TL approaches. CO was observed in all temporal bones that had undergone TL surgery. Among temporal bones that had undergone MF or RS surgeries, 5/6 had no CO, and 1/6 had partial ossification. This single case was noted to have intraoperative vestibular violation after RS surgery upon histopathologic and chart review.
In this temporal bone series, all temporal bones that had undergone TL demonstrated varying degrees of CO on histological analysis. MF and RS cases did not exhibit CO except in the case of vestibular violation. When cochlear implantation is planned or possible after VS surgery, surgeons may consider using a surgical approach that does not violate the labyrinth.
本研究旨在探讨经迷路（TL）、中颅窝（MF）和乙状窦后（RS）入路行前庭神经鞘瘤（VS）手术患者的尸检颞骨耳蜗骨化（CO）模式。
尸检颞骨的组织病理学分析。
多机构国家颞骨库。
在加利福尼亚大学洛杉矶分校国立耳聋与沟通障碍研究所和 House 颞骨实验室以及马萨诸塞眼耳耳科病理学实验室，搜索了有 VS 病史且接受过显微手术的尸检颞骨。排除标准包括非 VS 和术后 30 天内死亡。对颞骨进行基底、中间和顶部 CO 的组织学分析。
从两个数据库中筛选出 92 例有 schwannoma 病史的颞骨，其中 12 例符合纳入标准。肿瘤切除的方法包括 2 例 MF、4 例 RS 和 6 例 TL。所有接受 TL 手术的颞骨均观察到 CO。接受 MF 或 RS 手术的颞骨中，5/6 无 CO，1/6 部分骨化。组织病理学和图表回顾发现，这一例在 RS 手术后出现术中前庭破坏。
在本颞骨系列中，所有接受 TL 手术的颞骨在组织学分析中均表现出不同程度的 CO。MF 和 RS 病例未出现 CO，除了一例出现前庭破坏。当计划或可能在 VS 手术后进行耳蜗植入时，外科医生可能会考虑使用不破坏迷路的手术入路。
