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双侧耳蜗神经鞘瘤:肿瘤切除及外侧壁电极耳蜗植入后的组织病理学证实和结果。

Bilateral intracochlear schwannomas: histopathological confirmation and outcomes following tumour removal and cochlear implantation with lateral wall electrodes.

机构信息

Department of Otolaryngology, Sir Charles Gairdner Hospital, Hospital Avenue, 6009, Nedlands, Perth, Western Australia, Australia.

Division of Surgery, Medical School, University of Western Australia, Nedlands, Perth, Western Australia, Australia.

出版信息

HNO. 2023 Dec;71(12):802-808. doi: 10.1007/s00106-023-01379-7. Epub 2023 Oct 30.

Abstract

Intracochlear schwannomas (ICS) are very rare benign tumours of the inner ear. We present histopathological proof of the extremely rare bilateral occurrence of intracochlear schwannomas with negative blood genetic testing for neurofibromatosis type 2 (NF2). Bilateral schwannomas are typically associated with the condition NF2 and this case is presumed to have either mosaicism for NF2 or sporadic development of bilateral tumours. For progressive bilateral tumour growth and associated profound hearing loss, surgical intervention via partial cochleoectomy, tumour removal, preservation of the modiolus, and simultaneous cochlear implantation with lateral wall electrode carrier with basal double electrode contacts was performed. The right side was operated on first with a 14-month gap between each side. The hearing in aided speech recognition for consonant-nucleus-consonant (CNC) phonemes in quiet improved from 57% to 83% 12 months after bilateral cochlear implantation (CI). Bilateral intracochlear schwannomas in non-NF2 patients are extremely rare but should be considered in cases of progressive bilateral hearing loss. Successful tumour removal and cochlear implantation utilizing a lateral wall electrode is possible and can achieve good hearing outcomes.

摘要

耳蜗神经鞘瘤(ICS)是内耳非常罕见的良性肿瘤。我们提供了内耳神经鞘瘤双侧发生的组织病理学证据,且血液基因检测为神经纤维瘤病 2 型(NF2)阴性。双侧神经鞘瘤通常与 NF2 相关,本例被认为是 NF2 镶嵌现象或双侧肿瘤的散发性发生。对于进行性双侧肿瘤生长和相关的严重听力损失,通过部分耳蜗切除术、肿瘤切除、保持耳蜗轴突和同时进行耳蜗植入以及带有基底双电极触点的外侧壁电极载体进行了手术干预。先对右侧进行手术,每侧间隔 14 个月。双侧耳蜗植入后 12 个月,助听听阈识别辅音-核-辅音(CNC)音的言语识别率从 57%提高到 83%。非 NF2 患者的双侧耳蜗神经鞘瘤极为罕见,但对于进行性双侧听力损失的患者,应考虑到这种情况。利用外侧壁电极进行成功的肿瘤切除和耳蜗植入是可能的,并可获得良好的听力效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ba5/10663204/90398677388a/106_2023_1379_Fig1_HTML.jpg

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