听神经瘤保留听力乙状窦后手术中背侧耳蜗核动作电位术中监测：短期听力结局的预测分析

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中文摘要

目的： 本研究旨在评估在乙状窦后听神经瘤切除术中使用4触点深部电极连续术中监测背侧耳蜗核动作电位（DNAP）的安全性和短期预测价值，并将其预测术后听力结局的准确性标准听性脑干反应（ABR）进行比较。
方法： 纳入术前言语识别率（WRS）≥50%并接受初次乙状窦后听神经瘤切除术的成年患者，进行这项回顾性队列研究。采用包括ABR、耳蜗神经动作电位定位和连续DNAP监测的多模式监测方案。术后5-7天根据两项标准评估短期听力结局：可服务听力（美国耳鼻咽喉头颈外科学会A或B级）和言语功能保留（WRS≥50%）。进行多变量Firth logistic回归和受试者工作特征（ROC）曲线分析，以确定独立预测因素并确定DNAP振幅的最佳预测阈值。在有随访资料的患者中，评估6个月听力结局。
结果： 总体而言，本分析纳入153例患者（93例女性，平均年龄42岁[范围18-68岁]），平均肿瘤直径2.2 cm（范围1.5-4.3 cm）。80.4%（123/153）的患者成功记录到稳定的基线DNAP信号，而ABR为60.8%（93/153）。没有与深部电极相关的手术并发症。术后5-7天，41.2%（63/153）的患者达到可服务听力，56.2%（86/153）的患者保留言语功能。在6个月随访时，在有可用听力图数据的患者中，相应比例分别为40.9%（56/137）和56.2%（77/137）。在多变量分析中，DNAP保留仍然是早期和6个月听力相关结局最一致的独立预测因素。ROC分析确定DNAP残余振幅比的最佳截断值为0.41，用于预测早期术后结局。在有6个月随访资料的组中，DNAP保持了良好的诊断性能，并且敏感性始终高于ABR。
结论： 通过4触点深部电极进行DNAP监测是一种安全可靠的技术，在保留听力的听神经瘤手术中提供了稳健的近乎实时反馈。DNAP残余振幅比>0.41与良好的早期听力结局密切相关，其诊断优势在6个月随访时仍然明显。

英文摘要

OBJECTIVE: The aim of this study was to evaluate the safety and short-term predictive value of continuous intraoperative monitoring of the dorsal cochlear nucleus action potential (DNAP) using a 4-contact depth electrode during retrosigmoid vestibular schwannoma resection, and to compare its accuracy in predicting postoperative hearing outcomes with that of standard auditory brainstem response (ABR).
METHODS: Adult patients with a preoperative word recognition score (WRS) ≥ 50% who underwent primary retrosigmoid vestibular schwannoma resection were included in this retrospective cohort study. A multimodal monitoring protocol comprising ABR, cochlear nerve action potential mapping, and continuous DNAP monitoring was used. Short-term hearing outcomes were assessed 5-7 days postoperatively based on two criteria: serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery class A or B) and speech function preservation (WRS ≥ 50%). Multivariate Firth logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors and determine the optimal predictive threshold for DNAP amplitude. In patients with available follow-up, 6-month hearing outcomes were assessed.
RESULTS: Overall, 153 patients (93 female, mean age 42 years [range 18-68 years]) were included in this analysis, with a mean tumor diameter of 2.2 cm (range 1.5-4.3 cm). Stable baseline DNAP signals were successfully recorded in 80.4% (123/153) of patients compared with 60.8% (93/153) for ABR. No procedure-related complications were attributable to the depth electrode. At 5-7 days postoperatively, serviceable hearing was achieved in 41.2% (63/153) and speech function in 56.2% (86/153) of patients. At the 6-month follow-up, the corresponding rates were 40.9% (56/137) and 56.2% (77/137), respectively, among patients with available audiometric data. In the multivariable analyses, DNAP preservation remained the most consistent independent predictor of both early and 6-month hearing-related outcomes. ROC analysis identified an optimal DNAP residual amplitude ratio cutoff of 0.41 for early postoperative outcomes. In the group with available 6-month follow-up, DNAP retained favorable diagnostic performance and consistently higher sensitivity than that of ABR.
CONCLUSIONS: DNAP monitoring via a 4-contact depth electrode was a safe and reliable technique that provided robust nearly real-time feedback during hearing-preservation vestibular schwannoma surgery. A DNAP residual amplitude ratio > 0.41 was strongly associated with favorable early hearing outcomes, and its diagnostic advantage remained evident at the 6-month follow-up.