中型听神经瘤术中听力保存及影响因素  

Hearing Preservation and Influence Factors in Microsurgery of Middle Acoustic Neuromas

作　　者：丁晓东[1] 杨廷舰[1] 周建明[2] 张贺[1] 

机构地区：[1]山东省潍坊医学院附属医院神经外科,潍坊261031 [2]山东省潍坊医学院附属医院耳鼻喉科,潍坊261031

出　　处：《神经病学与神经康复学杂志》2006年第3期150-152,156,共4页Journal of Neurology and Neurorehabilitation

摘　　要：目的探讨中型听神经瘤听力保存的影响因素。方法回顾性研究了乙状窦后入路听神经瘤显微手术58例。其中,试图听力保存的中型肿瘤22例。术前、术后行听力学检测:纯音听阈(PTA)、言语识别率(SDS)和听觉诱发电位(BAEP),进行对比分析。结果全部58例病人中,听力得以较好保存的4例。除去未考虑听力保存的大型肿瘤,22例中型肿瘤中听力得以保存的(较好保存:PTA≤60dB,SDS≥50$;部分保存:PTA≤60dB,SDS≥50%)9例。12例肿瘤和耳蜗神经粘连重,10例没有粘连或粘连轻。结论肿瘤与耳蜗神经的分界面是否粘连是听力保存的重要影响因素。术中神经监测对指导肿瘤切除是有益的,但术者的局部解剖知识和显微外科技术仍是手术成功的最基本因素。Objective To determine hearing preservation and influence factors in microsurgery of middle acous- tic neuromas.Methods We retrospectively reviewed the results of 58 cases of acoustic neuroma who underwent mi- crosurgery through retrosigmoid approach.In this study,22 cases of middle tumors underwent surgery to attempt to preserve hearing.Pre-and postoperative audiograms were performed in all patients.The audiograms included pure tone average(PTA),speech discrimination score(SDS),and brainstem auditory evoked potential(BAEP).We systematically analyzed these audiograms.Results Of 58 patients,better hearing was preserved in 4 patients.Ex- cept the patients with larger tumors,in 22 patients with middle tumors,hearing was preserved(better hearing PTA≤ 60dB,SDS≥50%;poor hearing 60dB<PTA≤90dB,SDS<50%)in 9 patients.There were 12 patients with severe adhesion between the cochlear nerve and tumor capsule,and 10 had less adhesion or not.Conclusion The degree of adhesion formation between the cochlear nerve and the tumor is the important influence factor in hearing preserva- tion.Intraoperative monitoring contributes to guiding the resection,however the surgeon's knowledge of topographical landmarks and meticulous surgical technique remain the essential factors of success.

关 键 词：听神经瘤 手术 听力保存 耳蜗神经 粘连 影响因素 

分 类 号：R739.4[医药卫生—肿瘤]