前庭神经鞘瘤的频率特异性听力变化及ABR在小肿瘤中的更高敏感性

文献信息

中文摘要

背景： 前庭神经鞘瘤（VS）是一种良性前庭神经肿瘤。肿瘤大小与听觉功能障碍之间的关联，尤其是在小型VS中，仍不明确。
目的： 评估VS中随肿瘤增大而出现的听力学变化，并确定与听力损害相关的肿瘤大小阈值。
材料与方法： 我们回顾性分析了2008年至2025年间治疗的430例散发性VS患者。患者按Koos分级进行分类。回顾了临床特征、纯音测听、言语识别率、听性脑干反应（ABR）及磁共振成像结果。进行了多因素回归和受试者工作特征分析。
结果： 小型VS（Koos I-II级）的年度检出量显著增加。听力随Koos分级升高而恶化，表现为高频损害。Koos I级与II级之间的纯音和言语识别率相当，而ABR差异显著；超过60%的具有可用听力的Koos I级患者ABR异常。ROC确定了可用听力丧失的阈值为17.4 mm，ABR异常的阈值为13.4 mm。
结论与意义： 听力学损害随VS生长而进行性加重，小型与中大型肿瘤之间存在明显差异。ABR对小型VS的早期耳蜗后功能障碍具有更高的敏感性，可作为听力保留的术前预测指标，以支持临床决策。

英文摘要

BACKGROUND: Vestibular schwannoma (VS) is a benign vestibular nerve tumor. The association between tumor size and auditory dysfunction, especially in small VSs, remains unclear.
OBJECTIVES: To assess audiological changes with increasing tumor size in VS and identify tumor-size thresholds related to hearing impairment.
MATERIAL AND METHODS: We retrospectively analyzed 430 patients with sporadic VS treated between 2008 and 2025. Patients were classified by Koos grade. Clinical features, pure-tone audiometry, speech discrimination score, auditory brainstem response (ABR), and magnetic resonance imaging findings were reviewed. Multivariate regression and receiver operating characteristic analyses were performed.
RESULTS: Annual detection of small VS (Koos I-II) increased substantially. Hearing deteriorated with rising Koos grade, showing high-frequency impairment. Pure-tone and speech discrimination were comparable between Koos I and II, whereas ABR differed significantly; over 60% of Koos I patients with serviceable hearing had abnormal ABR. ROC identified thresholds of 17.4 mm for loss of serviceable hearing and 13.4 mm for ABR abnormality.
CONCLUSIONS AND SIGNIFICANCE: Audiological impairment worsens progressively as VS growth, with clear differences between small and medium-to-large tumors. ABR has superior sensitivity for early retrocochlear dysfunction in small VS and may serve as a preoperative predictor for hearing preservation to support clinical decision-making.