Huang Jiayu, Lin Jiaji, You Na, Li Xiaolong, Xiong Yongqin, Wang Xiaoyu, Lu Haoxuan, Li Chenxi, Li Runze, Hu Jianxing, Zhang Jun, Lou Xin
Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China.
Department of Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1392-1405. doi: 10.21037/qims-23-721. Epub 2024 Jan 12.
The mechanism underlying tinnitus remains unclear, and when it coexists with vestibular schwannoma (VS), it can significantly diminish the quality of life for affected patients. This study aimed to determine the correlation between preoperative clinical characteristics of VS, postoperative changes in brain function, and tinnitus in patients with VS through a cohort study.
We collected data from 80 patients with VS preoperatively and 28 patients with VS preoperatively and postoperatively, and recruited 28 healthy controls. We used Chi-squared tests and unpaired -tests to identify clinical characteristics with a significant preoperative effect. We used paired -tests to identify brain regions where patients demonstrated significant changes in amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) postoperatively. Tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS). Pearson correlation coefficients were applied to assess the relationship between the changes in ALFF and ReHo and the changes in THI and VAS scores postoperatively. We also conducted seed- and region of interest (ROI)-based functional connectivity (FC) analyses.
Before surgery, patients with VS with tinnitus (n=49) had smaller tumors (t=3.293; P<0.001), more solid tumor (χ=4.559; P=0.033), and less extrusion into the cerebellum brain stem (χ=10.345; P=0.001) than those without tinnitus (n=31). After surgery, the 28 patients with VS showed a significant reduction in ALFF in the left Cerebellum_Crus2 (a lobule in the cerebellum anatomy) (ROI 1) and a significant reduction in ReHo in the left Cerebellum_Crus1 (a lobule in the cerebellum anatomy) (ROI 2) and the right precuneus (ROI 3). Conversely, ReHo was significantly increased in the right precentral gyrus (ROI 4) [cluster-level P value family-wise error (P) <0.05]. The changes in ALFF values were negatively correlated with changes in the VAS score (r=-0.32; P<0.05). The FC strengths of patients between ROI 2 and the left and right posterior cingulate gyrus were significantly decreased postoperatively [false discovery rate (FDR) correction; P<0.05].
Preoperative tinnitus in patients with VS may be influenced by tumor characteristics. The functional activities of brain regions are possibly altered postoperatively, which may be involved in the maintenance of postoperative tinnitus. Notably, the changes in ALFF are correlated with tinnitus.
耳鸣的潜在机制尚不清楚，当它与前庭神经鞘瘤（VS）共存时，会显著降低受影响患者的生活质量。本研究旨在通过队列研究确定VS患者术前临床特征、术后脑功能变化与耳鸣之间的相关性。
我们收集了80例VS患者的术前数据以及28例VS患者的术前和术后数据，并招募了28名健康对照者。我们使用卡方检验和非配对t检验来确定术前有显著影响的临床特征。我们使用配对t检验来确定患者术后低频波动幅度（ALFF）和局部一致性（ReHo）有显著变化的脑区。使用耳鸣障碍量表（THI）和视觉模拟量表（VAS）评估耳鸣严重程度。应用Pearson相关系数来评估ALFF和ReHo的变化与术后THI和VAS评分变化之间的关系。我们还进行了基于种子点和感兴趣区域（ROI）的功能连接（FC）分析。
术前，伴有耳鸣的VS患者（n = 49）比无耳鸣的患者（n = 31）肿瘤更小（t = 3.293；P < 0.001），实性肿瘤更多（χ = 4.559；P = 0.033），向小脑脑干的挤压更少（χ = 10.345；P = 0.001）。术后，28例VS患者左侧小脑 Crus2（小脑解剖中的一个小叶）（ROI 1）的ALFF显著降低，左侧小脑Crus1（小脑解剖中的一个小叶）（ROI 2）和右侧楔前叶（ROI 3）的ReHo显著降低。相反，右侧中央前回（ROI 4）的ReHo显著增加[簇水平的P值采用族系误差（P）<0.05]。ALFF值的变化与VAS评分的变化呈负相关（r = -0.32；P < 0.05）。术后患者ROI 2与左右后扣带回之间的FC强度显著降低[错误发现率（FDR）校正；P < 0.05]。
VS患者术前耳鸣可能受肿瘤特征影响。术后脑区的功能活动可能发生改变，这可能与术后耳鸣的维持有关。值得注意的是，ALFF的变化与耳鸣相关。
