Mazzoni A, Calabrese V, Danesi G, De Nigris M
Divisione ORL Ospedali Riuniti, Bergamo.
Acta Otorhinolaryngol Ital. 1993 Jan-Feb;13(1):3-11.
In this study the Authors analyze 380 acoustic neuroma removals carried out from 1972 to 1992 focusing their attention on 90 attempts to save hearing by employing a suboccipital approach. In this series the facial nerve was preserved in 99% of the cases with completely normal function in 78%. The cochlear nerve was anatomically preserved in 96% of the subjects. According to the Shelton-Brackmann classification applied to evaluate hearing results, good hearing (Class A = PTA < or = 30 dB; SDS > or = 70%) was obtained in 12% of the cases, serviceable hearing (Class B = PTA < or = 50 dB; SDS > or = 50%) in 13%, measurable hearing (Class C = any measurable hearing) in 19% and anacusis (Class D) in 56% of the patients. CSF leak occurred in 6.6% of the cases, meningitis in 2.2%, paresis or paralysis of the ninth and tenth cranial nerves in 3% and ataxia in 2%. In acoustic neuroma surgery, hearing preservation is a new but complicated topic. In fact, some operative steps--such as the separation of tumor from nerves and arteries, tumor mass reduction, exposure of the end of the IAC--certainly influence surgical results, but are a matter of uncontrollable variance even within series from the same surgeon and render hearing preservation an innovative idea still awaiting, however, a controllable procedure. The ethical feasibility of hearing preservation is confirmed by our results in which hearing preservation attempts using a suboccipital approach have the same morbidity that the translabyrinthine route would have in the same patient.
在本研究中，作者分析了1972年至1992年间进行的380例听神经瘤切除术，重点关注采用枕下入路试图保留听力的90例手术。在这一系列病例中，99%的病例保留了面神经，其中78%功能完全正常。96%的受试者解剖学上保留了蜗神经。根据用于评估听力结果的谢尔顿-布拉克曼分类，12%的病例获得了良好听力（A类 = 纯音平均听阈≤30 dB；言语辨别得分≥70%），13%的病例获得了有用听力（B类 = 纯音平均听阈≤50 dB；言语辨别得分≥50%），19%的病例获得了可测量听力（C类 = 任何可测量的听力），56%的患者为全聋（D类）。6.6%的病例发生脑脊液漏，2.2%发生脑膜炎，3%发生第九和第十颅神经麻痹或瘫痪，2%发生共济失调。在听神经瘤手术中，保留听力是一个新的但复杂的课题。事实上，一些手术步骤——如将肿瘤与神经和动脉分离、减少肿瘤体积、暴露内听道末端——肯定会影响手术结果，但即使在同一外科医生的系列病例中也是不可控变量的问题，使得保留听力成为一个仍在等待可控手术方法的创新理念。我们的结果证实了保留听力在伦理上的可行性，即采用枕下入路保留听力的尝试与同一患者采用迷路后入路具有相同的发病率。
