Scheich Matthias, Bürklein Miriam, Stöth Manuel, Bison Brigitte, Hagen Rudolf, Hackenberg Stephan, Vogt Marius L
Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
Brain Sci. 2024 Mar 20;14(3):295. doi: 10.3390/brainsci14030295.
The middle cranial fossa (MCF) approach is a well-established procedure in surgery of the internal auditory canal, as well as with the retrosigmoid and translabyrinthine approaches. It is commonly used in the hearing-preserving microsurgery of small vestibular schwannomas (VS). The debate about the "best" approach for the microsurgery of small VS without contact to the brainstem is controversial. It has been stated that the MCF approach leads to irreversible damage to the temporal lobe, which may be evident in follow-up magnet resonance imaging (MRI) as gliosis in up to 70% of patients.
This study represents a retrospective chart analysis conducted at a tertiary university hospital. Here, 76 postoperative MRIs were re-evaluated by an experienced neuroradiologist and compared with the preoperative images. Temporal lobe gliosis was classified on an ordinal scale as absent, slight, moderate or severe. Occurrence of gliosis was matched to the clinical predictors (tumor stage, tumor volume, sex, age, and side).
No case of severe or moderate gliosis was found in the patient group. Slight gliosis of the temporal lobe was rare and was only detected in four patients (5%). There was no relation between clinical predictors and the incidence of gliosis.
In our cohort, postoperative MR imaging did not reveal relevant damage to the temporal lobe parenchyma. This confirms the safe concept of microsurgery of small tumors via the middle fossa approach. The severe glioses described in other studies may be caused by a forced insertion of the retractor or by more extended approaches. However, further prospective neurocognitive studies seem to be necessary in order to assess functional changes in the temporal lobe.
中颅窝（MCF）入路是内耳道手术中一种成熟的手术方法，与乙状窦后入路和经迷路入路一样常用。它常用于小型前庭神经鞘瘤（VS）的保留听力显微手术。关于小型VS显微手术且不接触脑干的“最佳”入路存在争议。有人指出，MCF入路会导致颞叶不可逆损伤，在随访磁共振成像（MRI）中，高达70%的患者可能表现为胶质增生。
本研究是在一家三级大学医院进行的回顾性病历分析。在此，由一位经验丰富的神经放射科医生对76例术后MRI进行重新评估，并与术前图像进行比较。颞叶胶质增生按顺序量表分为无、轻度、中度或重度。胶质增生的发生情况与临床预测因素（肿瘤分期、肿瘤体积、性别、年龄和侧别）相匹配。
患者组未发现重度或中度胶质增生病例。颞叶轻度胶质增生罕见，仅在4例患者（5%）中检测到。临床预测因素与胶质增生的发生率之间无关联。
在我们的队列中，术后MRI未显示颞叶实质有相关损伤。这证实了经中颅窝入路进行小肿瘤显微手术的安全性。其他研究中描述的严重胶质增生可能是由牵开器的强行插入或更广泛的入路引起的。然而，似乎有必要进行进一步的前瞻性神经认知研究，以评估颞叶的功能变化。
