Hearing restoration after resection of an intracanalicular vestibular schwannoma: a role for emergency surgery?（聽神經(jīng)瘤切除術(shù)后的聽力恢復(fù)：急診手術(shù)的意義）

　　原文英文摘要：

　　Patients with vestibular schwannomas (VSs) most commonly present with sensorineural hearing loss, which is often insidious or gradual. Up to 26% of patients may present with sudden hearing loss, however, which poses an important surgical challenge. Sudden hearing loss has been attributed to spasm or occlusion of the labyrinthine artery resulting from tumor compression, and it is usually treated with corticosteroids. Hearing preservation surgery is not usually attempted in patients who have poor or nonserviceable hearing preoperatively.

　　The authors describe a 68-year-old man with complete deafness of the left ear since childhood, who developed sudden, profound sensorineural hearing loss in the right ear. Magnetic resonance imaging revealed a small right-sided intracanalicular tumor. Treatment with high-dose corticosteroids produced only minimal improvement in hearing. Subsequent emergency decompression and resection of a VS resulted in rapid improvement and restoration of hearing, with facial nerve preservation.

　　Although most neurotologic lesions in patients with hearing in only one ear are managed nonsurgically, resection of small tumors in the setting of sudden hearing loss should be considered in selected cases. This finding indicates that a therapeutic window may exist during which sudden hearing loss caused by intracanalicular tumors is reversible.

　　中文摘要：

　　聽神經(jīng)瘤（前庭神經(jīng)鞘瘤，VSs）患者經(jīng)常出現(xiàn)感音神經(jīng)性聽力損失，這通常是隱匿性或漸進(jìn)性的。然而，高達(dá)26％的患者可能會(huì)出現(xiàn)突然的聽力喪失，這對(duì)外科手術(shù)提出了重要的挑戰(zhàn)。突然聽力下降被歸因于腫瘤壓迫導(dǎo)致迷宮動(dòng)脈痙攣或閉塞，通常用皮質(zhì)類固醇治療。術(shù)前聽力差或無法使用的患者通常不嘗試聽力保護(hù)手術(shù)。

　　作者描述了一個(gè)68歲的男士，他從小左耳就完全失聰，他的右耳突然發(fā)生了嚴(yán)重的感覺神經(jīng)性聽力喪失。磁共振成像顯示右側(cè)小管內(nèi)腫瘤。用大劑量皮質(zhì)類固醇治療只能使聽力好轉(zhuǎn)較小。隨后緊急減壓和VS切除術(shù)可快速好轉(zhuǎn)和恢復(fù)聽力，并保留面神經(jīng)。

　　盡管只有一只耳朵的聽覺患者大多數(shù)神經(jīng)系統(tǒng)病變是通過非手術(shù)治療的，但在某些情況下應(yīng)考慮在突然失聰?shù)那闆r下切除小腫瘤。該發(fā)現(xiàn)表明治療效果可能存在，在此期間可逆轉(zhuǎn)由小管內(nèi)腫瘤引起的突然聽力損失。

　　國際神經(jīng)外科學(xué)院(WANS)院長、INC國際神經(jīng)外科醫(yī)生集團(tuán)的William T. Couldwell教授對(duì)于聽神經(jīng)瘤中顱窩入路顯微手術(shù)治療頗有研究。在其研究報(bào)告《Middle fossa approach for resection of vestibular schwannoma》中，教授表示中顱窩入路(MFA)可大幅度的保留聽神經(jīng)瘤患者的聽力，相對(duì)于其他方法更低的發(fā)病率和死亡率。William T. Couldwell教授治療下的聽神經(jīng)瘤患者聽力保存率為75.5%，面部功能保存率達(dá)到了90%之高。

　　參考文獻(xiàn)：https://sci-hub.se/http://link.springer.com/article/10.1007/s00701-017-3169-1

　　Couldwell教授擅長腦部、顱底、神經(jīng)腫瘤、垂體瘤、聽神經(jīng)瘤、癲癇和腦血管疾病等的外科治療。主要研究包括顱底腫瘤的外科管理；腦膠質(zhì)瘤、垂體腺瘤與腦膜瘤中的信號(hào)轉(zhuǎn)導(dǎo)與凋亡；多種神經(jīng)外科疾病如動(dòng)脈瘤和各種腦瘤的遺傳性等。曾發(fā)表400篇同業(yè)評(píng)審的文章，著述超過100本書籍章節(jié)、7本書籍，且多次獲得了美國聯(lián)邦與其他研究款項(xiàng)。他還是美國神經(jīng)外科醫(yī)師協(xié)會(huì)的全國際同行評(píng)審、電子出版物 Neurosurgical Focus 的主編，曾在多家期刊的編輯委員會(huì)任職，包括美國神經(jīng)外科醫(yī)師協(xié)會(huì)（AANS）神經(jīng)外科醫(yī)生、神經(jīng)病學(xué)雜志、神經(jīng)外科和精神病學(xué)、神經(jīng)腫瘤學(xué)雜志和神經(jīng)外科雜志。

　　目前任職美國猶他大學(xué)醫(yī)學(xué)院神經(jīng)外科主席，也是INC國際神經(jīng)外科醫(yī)生集團(tuán)旗下國際神經(jīng)外科顧問團(tuán)成員，2019年4月，他曾來華在INC中國代表處上海辦公室舉辦學(xué)術(shù)沙龍，與國內(nèi)神經(jīng)外科醫(yī)生開展技術(shù)交流。2019年11月9日，Couldwell教授也將來華參與INC主辦的二屆國際神經(jīng)外科顧問團(tuán)年會(huì)，屆時(shí)他還將為國內(nèi)有需要的聽神經(jīng)瘤患者提供面對(duì)面的醫(yī)療咨詢。

• 文章標(biāo)題：聽神經(jīng)瘤切除術(shù)后的聽力恢復(fù)：急診手術(shù)的意義
• 更新時(shí)間：2019-10-29 16:17:19