小前庭神经鞘瘤患者接受中颅窝开颅术的肿瘤起源神经与听力保留结局
Tumor Nerve of Origin and Hearing Preservation Outcomes for Patients With Small Vestibular Schwannomas Undergoing Middle Fossa Craniotomy.
文献信息
| PMID | 42767622 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pawina Jiramongkolchai |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 评估接受中颅窝（MCF）入路显微手术切除的小散发性前庭神经鞘瘤（VS）患者中，基于肿瘤起源神经的听力保留（HP）结局。
研究设计： 回顾性单机构研究。
地点： 三级学术机构。
患者： 18岁及以上患有小散发性VS（≤15 mm）的成人。
干预： MCF。
主要结局指标： 听力保留定义为词语识别得分≥50%。
结果： 在189例连续接受手术的患者中，164例（89%）在术中对肿瘤起源神经进行了识别。在这164例患者中，88例（54%）为下前庭神经（IVN）肿瘤，76例（46%）为上前庭神经（SVN）肿瘤。SVN肿瘤患者的听力保留率为83%，而IVN肿瘤患者为49%。按大小分层时，SVN起源且大小≤5 mm的肿瘤HP率最高（91%）。在多变量分析中，与大小超过10 mm的SVN肿瘤患者相比，大小≤5 mm的SVN肿瘤患者HP增加7.5倍（95% CI：1.60-34.9）。两组之间面神经结局无显著差异。在初次随访时，SVN肿瘤患者中有70例（92%）和IVN肿瘤患者中有83例（94%）分别为HB 1/2。
结论： 与小SVN肿瘤患者相比，小SVN肿瘤患者具有显著更高的HP可能性以及更短的手术时间，提示在合适的候选者中，早期手术干预可能有益。
英文摘要
OBJECTIVE: To evaluate hearing preservation (HP) outcomes based on tumor nerve origin for patients with small sporadic vestibular schwannomas (VS) undergoing microsurgical resection using the middle cranial fossa (MCF) approach.
STUDY DESIGN: Retrospective single-institution study.
SETTING: Tertiary academic institution.
PATIENTS: Adults 18 years or older with small sporadic VS (≤15 mm).
INTERVENTION: MCF.
MAIN OUTCOME MEASURE: Hearing preservation is defined as a word recognition score of ≥50%.
RESULTS: Of the 189 consecutive patients who underwent surgery, 164 (89%) had intraoperative identification of the tumor nerve of origin. Of those 164 patients, 88 (54%) had inferior vestibular nerve (IVN) tumors, and 76 (46%) had superior vestibular nerve (SVN) tumors. Hearing was preserved in 83% of patients with SVN tumors compared with 49% of patients with IVN tumors. When stratified by size, the rate of HP was highest (91%) for tumors of SVN origin ≤5 mm in size. In multivariate analysis, patients with SVN tumors ≤5 mm in size had a 7.5-fold increase (95% CI: 1.60-34.9) in HP compared with patients with SVN tumors larger than 10 mm in size. There was no significant difference in facial nerve outcomes between the 2 groups. At initial follow-up, 70 (92%) patients with SVN tumors and 83 (94%) patients with IVN tumors had a HB 1/2, respectively.
CONCLUSIONS: Patients with small SVN tumors have a significantly higher likelihood of HP as well as shorter operative time compared with IVN tumors, suggesting that, in appropriate candidates, early surgical intervention may be beneficial.