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目的分析听神经鞘瘤显微术后影响有效听力的因素。方法 47例听神经鞘瘤在术中听力监护下行枕下乙状窦后入路显微切除术。记录肿瘤的大小、术前听力、肿瘤存内听道的充满程度以及肿瘤与听神经的粘连程度。结果肿瘤均全切,听神经解剖保留75．7％,47例病人有效听力保留率为21．2％。肿瘤直径≤15 mm的28例中有效听力保留率为32．2％,肿瘤直径≥16 mm的19例中有效听力保留率为5．3％。在25例病人中,影像资料显示16例内听道被肿瘤完全充满者有效听力保留率为25％,9例内听道部分充满者有效听力保留率为44．4％。28例肿瘤直径≤15 mm的病人中,16例术前听力为Ⅰ级者术后有效听力保留率为37．5％,12例Ⅱ级以上者(包括Ⅱ级)术后有效听力保留率为 25％。肿瘤大小与内听道充满程度可作为术后有效听力独立影响因素(P<0．001,P=0．027)。而术前听力无统计学意义(P=0．233)。结论肿瘤不完全充满内听道以及其直径小于15 mm有利于有效听力保留,良好的术前听力似乎更有利于有效听力保留,但却没有统计学意义。肿瘤与听神经没有完整界面, 这一点会影响术后有效听力的保留。
Objective To analyze the factors influencing effective hearing after schizophrenia microscopy. Methods Forty-seven cases of auditory schwannoma underwent suboccipital retrosigmoidal posterior approach microsurgery undergoing intraoperative hearing monitoring. Record the size of the tumor, preoperative hearing, the degree of fullness of the auditory canal in the tumor, and the degree of adhesion between the tumor and the auditory nerve. Results All the tumors were completely resected. Auditory nerve anatomy retained 75.7%. The effective hearing retention rate of 47 patients was 21.2%. The effective hearing retention rate was 32.2% in 28 cases with tumor diameter ≤15 mm and 5.3% in 19 cases with tumor diameter ≥16 mm. In 25 patients, the imaging data showed that the effective hearing retention rate was 25% in 16 cases of complete invaded tracts of the tumor and 44.4% in 9 of 9 cases. Of the 28 patients with tumor diameter ≤15 mm, the effective hearing retention rate of the 16 patients with grade Ⅰ preoperative hearing was 37.5%. The effective hearing retention rate of 12 patients with grade Ⅱ or above (including grade Ⅱ) was 25%. Tumor size and degree of internal auditory canal can be used as an effective independent hearing influencing factors (P <0.001, P = 0.027). The preoperative hearing was not statistically significant (P = 0.233). Conclusion The tumor is not completely filled with the internal auditory canal and its diameter less than 15 mm is conducive to effective hearing retention, good preoperative hearing seems to be more conducive to effective hearing retention, but not statistically significant. Tumor and auditory nerve does not have a complete interface, which will affect the retention of effective hearing after surgery.