Post K D, Eisenberg M B, Catalano P J
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
J Neurosurg. 1995 Aug;83(2):191-6. doi: 10.3171/jns.1995.83.2.0191.
The goals in the management of patients with vestibular schwannomas have changed drastically over the past few decades, with preservation of useful hearing representing the newest challenge. The true incidence of preserved useful hearing, however, has become clouded by a lack of uniformity in reporting results. The authors have analyzed 56 consecutive cases, in which directed attempts were made to preserve hearing on the involved side, to understand what factors play a major role in postoperative hearing preservation. Of the 56 cases reviewed, there were 46 patients who had "good" preoperative hearing (pure tone average < 50 dB; speech discrimination score > 50%). We found that, in this group of patients, if the tumor was less than 2 cm in diameter from pons to petrous, there was a 52% (16 of 31 patients) chance of preserving good hearing and if the tumor was 1 cm or less, the chances increased to 83%. Factors such as preoperative hearing status, tumor size and location, tumor consistency, and preoperative and intraoperative brainstem auditory evoked potentials are discussed in detail as they relate to postoperative outcome.
在过去几十年中，前庭神经鞘瘤患者的治疗目标发生了巨大变化，保留有用听力成为最新的挑战。然而，由于报告结果缺乏一致性，保留有用听力的真实发生率变得模糊不清。作者分析了连续56例病例，其中直接尝试保留患侧听力，以了解哪些因素在术后听力保留中起主要作用。在回顾的56例病例中，有46例患者术前听力“良好”（纯音平均听阈<50dB；言语识别率>50%）。我们发现，在这组患者中，如果肿瘤从脑桥到岩骨的直径小于2cm，保留良好听力的几率为52%（31例患者中有16例），如果肿瘤为1cm或更小，几率则增至83%。术前听力状况、肿瘤大小和位置、肿瘤质地以及术前和术中脑干听觉诱发电位等因素与术后结果的关系将详细讨论。
