影响听神经鞘瘤术后有效听力的因素分析  

The factors influencing serviceable hearing after operative preservation of acoustic neuroma

作　　者：尹卫宁[1] 刘隆熙[1] 崔洁 秦作荣[1] 孟庆海[3] 

机构地区：[1]青岛大学医学院附属海慈医院神经外科,青岛266033 [2]青岛市胸科医院,青岛266042 [3]青岛大学附属医院神经外科,青岛266001

出　　处：《中华神经医学杂志》2006年第5期516-518,共3页Chinese Journal of Neuromedicine

摘　　要：目的分析听神经鞘瘤显微术后影响有效听力的因素。方法 47例听神经鞘瘤在术中听力监护下行枕下乙状窦后入路显微切除术。记录肿瘤的大小、术前听力、肿瘤存内听道的充满程度以及肿瘤与听神经的粘连程度。结果肿瘤均全切,听神经解剖保留75．7％,47例病人有效听力保留率为21．2％。肿瘤直径≤15 mm的28例中有效听力保留率为32．2％,肿瘤直径≥16 mm的19例中有效听力保留率为5．3％。在25例病人中,影像资料显示16例内听道被肿瘤完全充满者有效听力保留率为25％,9例内听道部分充满者有效听力保留率为44．4％。28例肿瘤直径≤15 mm的病人中,16例术前听力为Ⅰ级者术后有效听力保留率为37．5％,12例Ⅱ级以上者(包括Ⅱ级)术后有效听力保留率为 25％。肿瘤大小与内听道充满程度可作为术后有效听力独立影响因素(P<0．001,P=0．027)。而术前听力无统计学意义(P=0．233)。结论肿瘤不完全充满内听道以及其直径小于15 mm有利于有效听力保留,良好的术前听力似乎更有利于有效听力保留,但却没有统计学意义。肿瘤与听神经没有完整界面, 这一点会影响术后有效听力的保留。Objective To analyze the factors influencing serviceable hearing after preservative microsurgery of acoustic neuroma. Methods Acoustic neuromas were microsurgically removed in 47 patients through suboccipital retrosigmoid approach under acoustic monitoring. The size of tumor, the filling of internal auditory canal, the preoperative hearing, and the degree of adhesion between the acoustic nerve and the tumor were recorded and analyzed. Results All of the tumors were totally removed. The acoustic nerves in 75.7% of the 47 cases were anatomically preserved and the preservation of serviceable hearing was achieved in 21.2% of the 47 cases. Serviceable hearing were preserved in 32.2% of the 28 patients harboring a tumor less than 15 mm in diameter and in 5.3% of 19 cases with lesions more than 16ram in diameter （P〈0.001）. Among the 25 patients whose internal auditory canals had been fully occupied by neuroms by magnetic resonance images, serviceable hearing was preserved in 25% of the 16 cases with complete filling of internal auditory canal and in 44.4% of 9 patients with partial filling （P= 0.031）. For the 28 patients with tumors less than 15 mm in diameter, serviceable hearing was preserved in 37.5% of 16 patients with Class I hearing and 25% of 12 patients with class 11 hearing （P=0.132）, with respect to preoperative hearing quality. During operation, only one case was found to have an interface between acoustic nerve and tumor so that the serviceable hearing was satisfactorily attained. Both tumor size and the extent of internal auditory canal proved statistically significant in a multivariable analysis （P〈 0.001 and P=0.027, respectively）. Conclusion The tumor size less than 15mm in diameter and partial filling of the internal auditory canal are favorable factors for prereservation of serviceable hearing. Excellent preoperative hearing appears to be good for the prereservation of serviceable hearing but does not have statistical significance. Besides, incomplete interface between acoustic nerv

关 键 词：听神经鞘瘤 听力保留 

分 类 号：R739.4[医药卫生—肿瘤]