颅中窝入路听神经瘤切除术听力保留技术研究  

Hearing Preservation in the Middle Fossa Approach for Vestibular Schwannoma

作　　者：陈继跃 马晓彦 丁志伟 张驰 曹伟 王方园 吴南 王国建 韩维举 戴朴 韩东一 申卫东 杨仕明 CHEN Jiyue;MA Xiaoyan;DING Zhiwei;ZHANG Chi;CAO Wei;WANG Fangyuan;WU Nan;WANG Guojian;HAN Weiju;DAI Pu;HAN Dongyi;SHEN Weidong;YANG Shiming(Senior Department of Otolaryngology-Head&Neck Surgery,the Sixth Medical Center of PLA General Hospital,National Clinical Research Center for Otolaryngologic Diseases,State Key Lab of Hearing Science,Ministry of Education,Beijing Key Lab of Hearing Impairment Prevention and Treatment,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科医学部国家耳鼻咽喉疾病临床医学研究中心,聋病教育部重点实验室聋病防治北京市重点实验室,北京100853

出　　处：《协和医学杂志》2021年第6期933-939,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金面上项目(81770991);科技部十三五国家重点研发计划课题(2019YFC0840707,2019YFC0121302)。

摘　　要：目的探讨颅中窝入路听神经瘤切除术中听力保留技术。方法回顾性收集并分析2006年5月至2021年5月中国人民解放军总医院行经颅中窝入路管内型听神经瘤切除术患者临床资料。术前均行听力测试、颅脑影像学检查,评估患者是否符合听力保留原则。术前与术后,均采用美国耳鼻咽喉⁃头颈外科学会听力分级标准进行听力分级评定,采用House⁃Brackmann(HB)分级进行面神经功能评定。总结不同临床特征的患者听力保留情况。结果共22例符合纳入和排除标准的管内型听神经瘤患者入选本研究。其术前面神经功能HB分级Ⅰ级21例,Ⅲ级1例;77.3%(17/22,95%CI:58.3%~96.3%)术前有实用听力,86.4%(19/22,95%CI:70.8%~100%)有可用听力;符合听力保留原则17例,余5例保留残余听力。22例患者均完整切除肿瘤,术后均无脑脊液漏、硬膜外血肿、感染等并发症发生。术后实用听力保留率为52.9%(9/17,95%CI:26.5%~79.4%),可用听力保留率为73.7%(14/19,95%CI:51.9%~95.5%)。术前颅脑MRI检查存在/不存在“脑脊液帽”患者术后实用听力保留率分别为60.0%(3/5,95%CI:23.1%~96.9%)、50.0%(6/12,95%CI:16.8%~83.2%),可用听力保留率分别为80.0%(4/5,95%CI:24.5%~100%)、71.4%(10/14,95%CI:44.4%~98.5%)。肿瘤来源于前庭上神经/前庭下神经患者术后实用听力保留率分别为33.3%(2/6,95%CI:0~87.5%)、55.6%(5/9,95%CI:14.0%~96.1%),可用听力保留率分别为57.1%(4/7,95%CI:7.7%~100%)、80.0%(8/10,95%CI:49.8%~100%)。肿瘤与蜗神经粘连/无粘连患者术后实用听力保留率分别为41.7%(5/12,95%CI:8.9%~74.4%)、80.0%(4/5,95%CI:24.5%~100%),可用听力保留率分别为66.7%(8/12,95%CI:35.4%~98.0%)、85.7%(6/7,95%CI:50.8%~100%)。中位随访4.9年,22例患者均无肿瘤复发,末次随访时HB分级I级21例,Ⅳ级1例。结论颅中窝入路听神经瘤完整切除术中保留听力,应考虑术前听力水平、影像学特征,以及把握合适的切除时机;术中需准确判断肿瘤�Objective To discuss the middle fossa approach(MFA)for vestibular schwannoma(VS)and hearing preservation(HP).Methods Retrospectively analyze the database of HP in patients that under⁃went MFA for intracanalicular VS from May 2006 to May 2021.Examinations of preoperative hearing and cranio⁃cerebral imaging were performed to evaluate whether the patients met the criterion of HP.The function of the co⁃chlear nerve was evaluated with American Academy of Otolaryngology⁃Head and Neck Surgery(AAO⁃HNS)hearing classification;the facial nerve function was evaluated with House⁃Brackmann(HB)grading.Different clinical characteristics regarding HP were summarized.Results A total of 22 patients with VS that met the in⁃clusion and exclusion criteria were included in this study.Facial nerve function was HB gradeⅠin 21 pa⁃tients,gradeⅢin 1 patient.The preoperative serviceable and usable HP rate were 77.3%(17/22,95%CI:58.3%-96.3%)and 86.4%(19/22,95%CI:70.8%-100%),respectively.Seventeen patients met the criterion of hearing preservation,and the other 5 got their residual hearing reserved.The tumor was completely removed in 22 patients with VS and without postoperative complications,such as cerebrospinal fluid(CSF)leakage,epidural hematoma or infection.The rates of postoperative serviceable and useful HP were 52.9%(9/17,95%CI:26.5%-79.4%)and 73.7%(14/19,95%CI:51.9%-95.5%),respectively.In the pa⁃tients present and those absent of CSF cap,the rates of postoperative serviceable HP were 60.0%(3/5,95%CI:23.1%-96.9%),50.0%(6/12,95%CI:16.8%-83.2%),and the rates of useful HP were 80.0%(4/5,95%CI:24.5%-100%),and 71.4%(10/14,95%CI:44.4%-98.5%),respectively.In the tumor originating from the superior vestibular nerve,the rates of postoperative serviceable HP and useful HP were 33.3%(2/6,95%CI:0-87.5%)and 57.1%(4/7,95%CI:7.7%-100%),respectively.Whereas in pa⁃tients with tumors originating from the inferior vestibular nerve,the rates of serviceable HP and useful HP were 55.6%(5/9,95%CI:14.0%-96.1%)and 80.0%(8/10,95%CI:49.8%

关 键 词：听神经瘤 颅中窝入路 听力保留 肿瘤来源 粘连 

分 类 号：R739.61[医药卫生—肿瘤]