概述诊断时具有对侧不可用听力的散发性前庭神经鞘瘤(VS)的可能决策过程。
回顾性病例系列。
从1995年至2013年,在三级转诊中心对诊断VS进行了研究。
28名患者被纳入,平均随访6.9年(范围=0.5-20年)。十个是阶段1,十个是阶段2,五个是阶段3,三个是阶段4。同侧听力水平为A(n=3),B(n=10),C(n=7)和D(n=8)美国耳鼻咽喉头颈外科学会分类。对侧听力水平为C(n=11)和D(n=17)。初始VS管理包括监测(n=12)或手术(n=16),4例患者随后接受了手术(n=3)或立体定向放射治疗(n=1)。听力通过助听器和/或病因治疗得到改善(n=8),通过对侧(n=15)或同侧(n=4)人工耳蜗(CI)修复,或同侧听觉脑干植入物(ABIs)(n=3)。最后,18CI每天活跃;其中14人表现出高或中等收益,平均开放式非音节单词得分(WRS)为58.1%,句子识别得分(SRS)为69.7%,但只有一个ABI仍然活跃(WRS为70%,SRS为87%,唇读)。
当没有必要提前去除VS时,最初可能会建议针对听力损失的对比CI或病因治疗。提出了IpsilateralCI,而如果先前的听力恢复不成功,则应对VS进行操作。ABI应保留用于在VS去除过程中无法植入对侧CI或切除耳蜗神经的罕见病例。
3喉镜,130:E407-E415,2020年。
To outline a possible decision-making process for sporadic vestibular schwannoma (VS) with contralateral nonserviceable hearing at diagnosis.
Retrospective case series.
Diagnosed VS was studied in a tertiary referral center from 1995 to 2013.
Twenty-eight patients were included, with a mean follow-up of 6.9 years (range = 0.5-20 years). Ten were stage 1, 10 were stage 2, five were stage 3, and three were stage 4. Ipsilateral hearing levels were A (n = 3), B (n = 10), C (n = 7) and D (n = 8) American Academy of Otolaryngology-Head and Neck Surgery classification. Contralateral hearing levels were C (n = 11) and D (n = 17). Initial VS management included surveillance (n = 12) or surgery (n = 16), and four patients were later treated with surgery (n = 3) or stereotactic irradiation (n = 1). Hearing was improved by hearing aids and/or etiological treatment (n = 8), restored by contralateral (n = 15) or ipsilateral (n = 4) cochlear implants (CIs), or ipsilateral auditory brainstem implants (ABIs) (n = 3). Finally, 18 CIs were active daily; 14 of them presented high or moderate benefit with mean open-set dissyllabic word scores (WRS) of 58.1% and sentence recognition scores (SRS) of 69.7%, but only one ABI was still active (WRS of 70% and SRS of 87% with lip reading).
When early removal of VS was not necessary, contralateral CI or etiological treatment for hearing loss might be recommended initially. Ipsilateral CI is proposed, whereas VS should be operated on if previous hearing restoration was not successful. ABI should be reserved for the rare cases where a contralateral CI could not be implanted or the cochlear nerve was sectioned during VS removal.
3 Laryngoscope, 130:E407-E415, 2020.