听力监测下前庭神经鞘瘤听力保留影响因素初步研究  

A Preliminary Study on Influencing Factors in Hearing Preservation in Vestibular Neurinoma Resection with Hearing Monitoring

作　　者：张鼎 王秀英 徐兴华 李翀 张军 ZHANG Ding;WANG Xiuying;XU Xinghua;LI Chong;ZHANG Jun(Chinese PLA General Hospital,Department of Neurosurgery,First Medical Center,Beijing100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心神经外科医学部,北京100853

出　　处：《中华耳科学杂志》2024年第4期632-637,共6页Chinese Journal of Otology

摘　　要：目的在脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)和耳蜗神经复合动作电位(cochlear nerve compound action potential,CAP)技术的多模态听力监测辅助下,对前庭神经鞘瘤手术中可能的听力保留影响因素进行初步研究,探讨多模态听力监测辅助的临床应用经验以及听力保留可能的影响因素。方法选取2018年4月至2020年1月中国人民解放军总医院第一医学中心神经外科收治的前庭神经鞘瘤患者24例,其中男性12例,女性12例;根据美国耳鼻咽喉头颈外科学会(American Academy of Otolaryngology-Head and Neck Surgery,AAO-HNS)分级标准分为听力保留组(AAO-HNS分级C级及以上)11例和听力未保留组(AAO-HNS分级D级)13例。采用乙状窦后入路前庭神经鞘瘤切除术,总结术中监测情况,结合患者术后听力保留情况进行分析研究。结果24例患者中,20例患者肿瘤达到全切,4例患者肿瘤近全切除。有11例患者(45.8%)在术后4周的随访中保存了可测听力,8例患者(38.1%)在术后4周的随访中保留了可用听力。听力保留组与听力未保留组患者肿瘤直径、术中肿瘤与神经粘连紧密与否紧密比较,差异有统计学意义(P<0.05)。结论听力保留情况与患者的肿瘤直径大小、术中肿瘤与神经粘连紧密具有一定的相关性。Objective To identify possible factors affecting hearing preservation during resection of vestibular schwannoma with the assistance of multimodal hearing monitoring using brainstem auditory evoked potentials(BAEP)and cochlear nerve compound action potentials(CAP)recording.Methods Data from patients undergoing vestibular schwannoma resection via the retrosigmoid sinus approach with BAEP and CAP multimodal hearing monitoring from April 2018 to January 2020 at the First Medical Center of PLA General Hospital(n=24,12 males and 12 females)were analyzed and summarized.Preoperative hearing was at AAO-HNS grade C or above in 11 cases(hearing preservation group)and AAO-HNS grade D or worse in 13 cases(non-hearing preservation group).Results Total resection was achieved in 20 cases,and subtotal resection in the rest 4 cases.Postoperative hearing was detectable in all 11 cases(45.8%)and rated as usable in 8 cases(38.1%)in the hearing preservation group at 4 weeks follow up.Significant differences between the two groups were noticed regarding tumor size and involvement with the auditory nerve.Conclusion Hearing preservation in vestibular schwannoma resection is closely related to tumor size and involvement of the auditory nerve.

关 键 词：前庭神经鞘瘤 脑干听觉诱发电位 耳蜗神经动作复合电位 听力保留 

分 类 号：R739.4[医药卫生—肿瘤]