Thomsen J, Zilstorff K, Tos M
J Laryngol Otol. 1983 Sep;97(9):801-12. doi: 10.1017/s0022215100095037.
The involvement of the trigeminal nerve, cerebellum, and optokinetic nystagmus in patients with acoustic neuromas, as well as the methods of investigation, are described. The corneal and/or facial sensibility was found to be reduced in 29 per cent of the whole series and in 53 per cent of tumors larger than 40 mm. There was a significant correlation between reduced corneal and/or facial sensibility and the findings of pressure at the trigeminal root at operation. Only three patients had a persistent reduction of trigeminal function post-operatively. Cerebellar dysfunction was found in 32 per cent, but significantly more frequently (58 per cent) in patients with tumors larger than 40 mm. Post-operatively, six patients had cerebellar symptoms in the form of gait disturbances; five of these patients had a supplementary suboccipital removal performed, after the initial translabyrinthine approach. A defective optokinetic nystagmus was found pre-operatively in 10 patients, nine of whom had tumors larger than 40 mm in diameter. All patients with a defective optokinetic nystagmus had a large anatomic impression in the pons at operation. In patients suspected of having an acoustic neuroma, symptoms from the trigeminal nerve, the cerebellum and the optokinetic nystagmus predict the presence of a large tumor and subsequent difficulties at operation. The symptoms were completely reversible in the vast majority of cases and post-operative symptoms persisted only in patients in whom tumor removal was difficult and the tumor very large. Testing of the trigeminal nerve, the cerebellum and the optokinetic nystagmus still deserves its place in the diagnostic work-up of patients with unilateral acoustic or vestibular symptoms, especially in cases with severe hearing impairment, which necessitate the use of tests that are independent of acoustic function.
本文描述了听神经瘤患者三叉神经、小脑及视动性眼震的受累情况以及相关检查方法。在整个病例系列中，29%的患者角膜和/或面部感觉减退，而在肿瘤直径大于40mm的患者中，这一比例为53%。角膜和/或面部感觉减退与手术中三叉神经根受压的表现之间存在显著相关性。术后仅有3例患者三叉神经功能持续减退。32%的患者存在小脑功能障碍，但在肿瘤直径大于40mm的患者中更为常见（58%）。术后，6例患者出现步态障碍形式的小脑症状；其中5例患者在初次经迷路入路手术后进行了枕下补充切除术。术前发现10例患者视动性眼震异常，其中9例肿瘤直径大于40mm。所有视动性眼震异常的患者在手术中脑桥均有较大的解剖压迹。在疑似听神经瘤的患者中，三叉神经、小脑及视动性眼震的症状提示存在较大肿瘤及后续手术困难。在绝大多数情况下，这些症状完全可逆，术后症状仅在肿瘤切除困难且肿瘤非常大的患者中持续存在。对三叉神经、小脑及视动性眼震的检查在单侧听力或前庭症状患者的诊断评估中仍有其价值，尤其是在严重听力损害的病例中，此时需要使用独立于听觉功能的检查。
