Wolf S R, Wigand M E, Berg M, Haid C T
Klinik und Poliklinik für Hals-Nasen-Ohrenkranke, Universität Erlangen-Nürnberg.
HNO. 1995 Jun;43(6):371-7.
Criteria for therapeutic decision-making for intrameatal acoustic neurinomas that are suspected radiologically.
Retrospective evaluation.
114 surgically treated patients of the ORL Dept. of the University Erlangen-Nuremberg.
Rate of complications. Preservation of facial nerve function and hearing. Preoperative time course of hearing. Reliability of radiological examination. Progression of symptoms and tumor growth.
Surgical exposure and complete removal by the enlarged middle cranial fossa approach.
In 47% of cases surgery confirmed a neurinoma limited to the internal auditory meatus. In 41%, tumors were larger than expected and had protruded into the cerebellopontine angle, indicating preoperative tumor growth during an average period of 5.4 months before surgery could be completed. The remaining 12% of patients were found to have a facial neurinoma, meningioma or non-tumorous lesion of the internal auditory canal. No permanent neurological deficits or fatalities occurred in any of the patients treated. Facial function was favorable in 88% and moderate pareses or synkineses occurred in 12%. The degree of hearing preservation depended on the preoperative situation. When the preoperative pure-tone average (at 0.5, 1, 2 and 4 kHz) was 30 dB or less, hearing levels of less than 90 dB could be preserved in 70% of cases. Findings also demonstrated that the complication rate and success of function preservation were similar to younger patients in patients older than 60 years (n = 21). Without surgery auditory acuity decreased by 10 dB per year. The volume of intrameatal neurinomas in 7/10 cases followed by MRI doubled during a median following time of 32 months.
Acoustic neurinoma surgery by the enlarged middle cranial fossa approach is a safe procedure with low complication rates. The percentages of preservation of facial function and hearing can be excellent in cases with small tumors and good preoperative hearing. To date no parameter has been found to predict tumor growth or the time course for hearing loss in individual cases. Surgical ablation of radiologically suspected, small acoustic neurinoma by the transtemporal approach is recommended.
为影像学怀疑的内耳道听神经瘤制定治疗决策标准。
回顾性评估。
埃尔朗根 - 纽伦堡大学耳鼻喉科114例接受手术治疗的患者。
并发症发生率。面神经功能和听力的保留情况。术前听力的时间进程。影像学检查的可靠性。症状进展和肿瘤生长情况。
采用扩大的中颅窝入路进行手术暴露并完全切除。
47%的病例手术证实听神经瘤局限于内耳道。41%的病例肿瘤比预期大，已突入桥小脑角，表明术前肿瘤在平均5.4个月的时间里生长，直至手术完成。其余12%的患者被发现患有面神经瘤、脑膜瘤或内耳道非肿瘤性病变。所有接受治疗的患者均未发生永久性神经功能缺损或死亡。88%的患者面神经功能良好，12%出现中度麻痹或联带运动。听力保留程度取决于术前情况。当术前纯音平均听阈（0.5、1、2和4kHz）为30dB或更低时，70%的病例可保留低于90dB的听力水平。研究结果还表明，60岁以上患者（n = 21）的并发症发生率和功能保留成功率与年轻患者相似。不进行手术，听力每年下降10dB。10例中有7例经MRI随访，内耳道听神经瘤体积在中位随访时间32个月内翻倍。
采用扩大的中颅窝入路进行听神经瘤手术是一种安全的手术，并发症发生率低。对于小肿瘤且术前听力良好的病例，面神经功能和听力的保留率可达到极佳水平。迄今为止，尚未发现可预测个别病例肿瘤生长或听力丧失时间进程的参数。建议采用经颞部入路手术切除影像学怀疑的小型听神经瘤。
