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目的探讨中型听神经瘤听力保存的影响因素。方法回顾性研究了乙状窦后入路听神经瘤显微手术58例。其中,试图听力保存的中型肿瘤22例。术前、术后行听力学检测:纯音听阈(PTA)、言语识别率(SDS)和听觉诱发电位(BAEP),进行对比分析。结果全部58例病人中,听力得以较好保存的4例。除去未考虑听力保存的大型肿瘤,22例中型肿瘤中听力得以保存的(较好保存:PTA≤60dB,SDS≥50$;部分保存:PTA≤60dB,SDS≥50%)9例。12例肿瘤和耳蜗神经粘连重,10例没有粘连或粘连轻。结论肿瘤与耳蜗神经的分界面是否粘连是听力保存的重要影响因素。术中神经监测对指导肿瘤切除是有益的,但术者的局部解剖知识和显微外科技术仍是手术成功的最基本因素。
Objective To investigate the influencing factors of hearing preservation in midsurgical acoustic neuroma. Methods A retrospective study of sigmoid sinus posterior access neuroma microsurgery in 58 cases. Among them, 22 cases of medium-sized tumors were tried to be preserved in hearing. Preoperative and postoperative audiological tests: pure tone threshold (PTA), speech recognition rate (SDS) and auditory evoked potentials (BAEP), for comparative analysis. Results Among the 58 patients, 4 cases were well preserved. In 9 cases of large tumors without hearing preservation, the hearing was preserved in 22 cases of moderate tumors (PTA≤60dB, SDS≥50 $; partial preservation: PTA≤60dB, SDS≥50%). 12 cases of tumor and cochlear nerve adhesion heavy, 10 cases of no adhesion or adhesion of light. Conclusion The adhesion of tumor and cochlear nerve interface is an important factor for hearing preservation. Intraoperative nerve monitoring is instructive in guiding the tumor resection, but the anatomical knowledge of the surgeon and the microsurgical technique are still the most basic factors for successful operation.