听神经瘤乙状窦后入路手术后听力保留影响因素分析

Influencing analysis of hearing preservation after retrosigmoid approach surgery for vestibular schwannoma

目的筛查乙状窦后入路听神经瘤切除术后听力保留的相关影响因素。方法纳入2018年1月至2021年1月在首都医科大学附属北京天坛医院行乙状窦后入路手术的317例听神经瘤患者,术前影像学检查评估肿瘤大小(Koos分级)、是否侵袭内听道底部和是否发生囊性变,美国耳鼻咽喉头颈外科学会(AAO-HNS)听力分级评估手术前后听力,单因素和多因素前进法Logistic回归分析筛查乙状窦后入路手术后听力损失相关危险因素。结果共35例患者实现术后听力保留(AAO-HNS分级A级和B级),整体听力保留率约为11.04%(35/317),均为术前听力正常患者。听力损失组年龄>45岁(χ^(2)=45.648,P=0.000)、Koos分级3~4级(χ^(2)=41.692,P=0.000)、肿瘤侵袭内听道底部(χ^(2)=30.252,P=0.000)、肿瘤囊性变(χ^(2)=23.888,P=0.000)和术前听力异常(χ^(2)=78.317,P=0.000)比例均高于听力保留组。Logistic回归分析,年龄>45岁(OR=36.211,95%CI:5.006~261.918;P=0.000)、Koos分级3~4级(OR=21.215,95%CI:2.867~156.963;P=0.003)、肿瘤侵袭内听道底部(OR=13.746,95%CI:3.005~62.880;P=0.001)和肿瘤囊性变(OR=8.336,95%CI:1.943~35.770;P=0.004)是乙状窦后入路手术后听力损失的危险因素。结论对于有听力保留需求的听神经瘤患者,乙状窦后入路手术安全、有效,年龄较小、肿瘤体积较小、肿瘤未侵袭内听道底部和无囊性变的患者更有可能实现术后听力保留。

Objective To investigate the influencing factors of hearing preservation after retrosigmoid approach surgery for vestibular schwannoma.Methods A total of 317 patients with vestibular schwannoma treated by retrosigmoid approach surgery in Beijing Tiantan Hospital from January 2018 to January 2021 were included.Tumor size(Koos grade),whether the tumor invaded the bottom of the internal auditory canal,and whether the tumor had cystic changes were evaluated by preoperative imaging examination.Hearing function was evaluated by the American Academy of Otolaryngology-Head and Neck Surgery(AAO-HNS)hearing classification before and after surgery.Univariate and multivariate forward Logistic regression analysis were used to investigate the related risk factors of hearing loss after retrosigmoid approach surgery.Results Among 317 patients,35 cases(11.04%)had postoperative hearing preservation(AAO-HNS A and B)and all of them had normal preoperative hearing.The rates of age>45 years old(χ^(2)=45.648,P=0.000),Koos grade 3-4(χ^(2)=41.692,P=0.000),invasion the bottom of internal auditory canal(χ^(2)=30.252,P=0.000),cystic changes(χ^(2)=23.888,P=0.000)and preoperative hearing abnormality(χ^(2)=78.317,P=0.000)in hearing loss group were higher than those in hearing preservation group.Logistic regression analysis showed the age>45 years old(OR=36.211,95%CI:5.006-261.918;P=0.000),Koos grade 3-4(OR=21.215,95%CI:2.867-156.963;P=0.003),invasion the bottom of internal auditory canal(OR=13.746,95%CI:3.005-62.880;P=0.001)and cystic changes in tumor(OR=8.336,95%CI:1.943-35.770;P=0.004)were the risk factors of hearing loss after retrosigmoid approach surgery.Conclusions Retrosigmoid approach surgery is a safe and effective surgical approach for patients with vestibular schwannoma to achieve hearing preservation.Younger patients,with smaller tumors,and without invasion the bottom of internal auditory canal and without cystic changes in tumors are more likely to have postoperative hearing preservation.