中华耳科学杂志2018，Vol.16Issue(3)：325-331,7.DOI:10.3969/j.issn.1672-2922.2018.03.013
80例听神经瘤患者的临床特点及治疗选择分析
Clinical Features and Treatment Strategy of Vestibular Schwannoma
摘要
Abstract
Objective To report clinical features in patients with vestibular schwannoma and discuss over treatment strategies. Methods Patients seen at the First Hospital of Peking University from January 2009 to December 2017 for vestibular schwannoma were included and their clinical features and treatments were reviewed. Results Eighty patients (34 males and 46 females, aging from 18 to 80 years, median=52 years) were included in the study. Lesion was on left side in 26 and on right side in 54 patients. The maximal tumor size in the cerebellopontine angle was 0 to 76 mm (mean=21.93 mm). Koos grading was I in 31 patients, II in 18 patients, III in 11 patients and IV in 20 patients. The tumor in-volved the internal auditory canal in 31 patients, the cerebellopontine angle in 30 patients and both in 19 patients. The most common initial clinical symptoms were progressive hearing loss (42.5%, 34/80) and tinnitus (23.75%, 19/80). Oth-er initial symptoms included sudden hearing loss, vertigo, headaches, nausea, dizziness, trigeminal neuralgia, gait insta-bility and facial numbness. The two leading clinical complaints were hearing loss (83.57%) and tinnitus (70%), with on-ly 7.5%of patients showing neither hearing loss nor tinnitus. According to WHO criteria, hearing was graded as normal in 11 patients, mild loss in 9 patients, moderate loss in 19 patients, severe loss in 3 patients and profound loss in 38 pa- tients. Tumor size (P＜0.01)and location (P＜0.001)were significantly different between patients with PTA≤60 dB HL and those with PTA＞60 dB HL. Eighteen of the 47 patients with hearing better than severe loss underwent speech audi-ometry test, and the speech discrimination score was≥90%in 5 patients,≥70%＜90%in 1 patient,≥50%＜70%in 5 pa-tients and＜50%in 7 patients. According to the AAO-HNS hearing classification, hearing was at level A in 6 patients, level B in 4 patient, level C in 1 patients and level D in 7 patients. Twenty eight patients received careful observation, 5 received gamma knife treatment, and the rest 47 received surgery. Koos tumor grading and hearing level between pa-tients receiving careful observation and those receiving surgery were different (P＜0.001 and P=0.018, respectively), but not the age. For the 28 patients undergoing careful observation (average 25.24 months), tumor size increased in 8 pa-tients and showed no significant changes in 20. Conclusions Most patients with vestibular schwannoma present with au-ditory symptoms (hearing loss and tinnitus). Early diagnosis relies on screening patients for aural symptoms. For pa-tients with small tumors (under 1.5 cm), careful observation can also yield good outcomes.关键词
听神经瘤/临床特点/治疗策略/随访观察Key words
Vestibular Schwannoma/ Clinical Features/ Treatment Stategy/ Follow-up Observation分类
医药卫生引用本文复制引用
顾红波,张燕梅,钟贞,王军,吴园丁,陈丽,刘玉和..80例听神经瘤患者的临床特点及治疗选择分析[J].中华耳科学杂志,2018,16(3):325-331,7.基金项目
北京市科委首都临床特色应用研究专项课题(项目编号:Z151100004015137) This project was supported by Beijing Municipal Science and Technology Commission Capital Special Topics Clinical Applica-tion Foundation Project (Z151100004015137). （项目编号:Z151100004015137）
