Samii M, Matthies C
Department of Neurosurgery, Nordstadt Hospital, Hannover, Federal Republic of Germany.
Adv Tech Stand Neurosurg. 1995;22:343-73. doi: 10.1007/978-3-7091-6898-1_6.
900 acoustic neurinomas were removed by the suboccipital approach at Nordstadt Neurosurgical Department from 1978 to 1992 by the same surgeon (M. S.). While 247 patients were deaf on the involved side before surgery, there were 653 patients ears with some preoperative hearing. Preservation of the cochlear nerve was always attempted, and the overall-rate of hearing preservation was 38% (249 of 653), regardless of pre- and postoperative quality of hearing or of tumour sizes. In small tumour sizes below 3 cm of diameter preservation rate was 51%, in large tumours above 3 cm of diameter it was 22%. A classification system of hearing quality was made up considering pure tone audiometric hearing losses (PTA HL) at 1 to 3 kHz, and individual maximum speech discrimination scores. The usefulness of the preserved hearing is further evaluated considering the quality of hearing in the contralateral ear, and by application of other classification schemes. Presentation of the surgical strategies and their refinements by personal experience provide the base for discussion questioning whether and how further progress may still be anticipated.
1978年至1992年期间，同一位外科医生（M.S.）在诺德施塔特神经外科采用枕下入路切除了900例听神经瘤。术前患侧耳聋的患者有247例，术前尚有听力的患者有653例。手术中始终尝试保留蜗神经，总体听力保留率为38%（653例中的249例），与术前和术后的听力质量以及肿瘤大小无关。直径小于3 cm的小肿瘤，听力保留率为51%；直径大于3 cm的大肿瘤，听力保留率为22%。根据1至3 kHz的纯音听力损失（PTA HL）以及个体最大言语辨别得分，制定了听力质量分类系统。结合对侧耳的听力质量，并应用其他分类方案，进一步评估了保留听力的效用。通过个人经验介绍手术策略及其改进方法，为讨论是否以及如何预期进一步进展提供了基础。
