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Hörergebnisse nach transtemporaler Resektion kleiner (T1/T2) Akustikusneurinome

Hearing results after middle fossa removal of small (T1/T2) vestibular schwannomas

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Zusammenfassung

Hintergrund

Ziel der Studie war die Evaluation aktueller Hörergebnisse nach transtemporaler Resektion von T1- und T2- Akustikusneurinomen (AKN) sowie die Analyse vergleichbarer Kollektive in der Literatur.

Patienten und Methoden

Zwischen Dezember 2005 und Februar 2015 wurden 208 Patienten in der Universitätsklinik Würzburg über einen transtemporalen Zugang an einem AKN operiert. Die audiologischen Messungen (Ton- und Sprachaudiogramm) wurden prä- und postoperativ sowie im follow-up durchgeführt, zusätzlich wurde prä- und intraoperativ eine „brainstem evoked response audiometry“ (BERA) abgleitet. Es erfolgte eine Kategorisierung nach American Academy of Otolaryngology – Head and Neck Surgery AAO-HNS bzw. Gardner-Robertson. Als Hörerhalt wurde das Verbleiben in der Hörkategorie A und B nach AAO-HNS gewertet.

Ergebnisse

Bei 167 der 208 Patienten lag präoperativ ein Hören der Kategorie A+B vor. Es handelte sich hierbei um 78 Tumoren mit rein intrameatalem (T1) und um 89 Tumoren mit extrameatalem Anteil ohne Kontakt zum Hirnstamm (T2). Bei 109 Patienten (65 %) konnte das Hören in dieser Kategorie erhalten bleiben. In der Gruppe der rein intrameatalen Tumoren fand sich ein Hörerhalt von 69 %. Eine Analyse der Literatur seit dem Jahr 2000 ergab ähnlich positive Ergebnisse (46–82 %).

Schlussfolgerungen

Die transtemporale AKN-Resektion hat sich als hörerhaltende chirurgische Technik bewährt. Speziell bei kleinen Tumoren ohne Kontakt zum Hirnstamm lassen sich gute Hörergebnisse erzielen. Dies sollte vor dem Hintergrund der Diskussion über eine frühzeitige hörerhaltende Operation berücksichtigt werden.

Abstract

Objective

The aim of this study was to evaluate the hearing results after surgery for T1 and T2 vestibular schwannomas (VS) via the middle cranial fossa (MCF) approach at one institution and to review outcomes in the recent literature.

Patients and methods

In our department, 208 consecutive patients have undergone surgery using the MCF approach between December 2005 and February 2015. Audiological testing included pure-tone audiometry, speech-discrimination-tests pre- and postoperatively, as well as a pre- and intraoperative brainstem evoked response audiometry (BERA). Hearing status was categorized according to the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) or Gardner-Robertson classification. Hearing preservation was assessed when postoperative values were still within class A + B.

Results

In 167 of the 208 patients, preoperative hearing levels corresponded to class A+B. In 78 tumors, extension of the VS was limited to the internal auditory canal (T1) and in 89 tumors there was an extrameatal growth without touching the brainstem (T2). In 109 patients (65 %), postoperative hearing was still in class A+B. In the group of intrameatal tumors, the hearing preservation rate was even 69 %. The analysis of the literature of the past 16 years revealed comparable results (46–82 %).

Conclusions

Surgery for VS using the MCF approach is an established technique for reliable tumor removal with an adequate rate of hearing preservation. For small tumors without brainstem contact, particularly satisfying results can be achieved. This should be taken into account when discussing the possibility of early hearing preservation surgery.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    M. Scheich, D. Ehrmann-Müller, W. Shehata-Dieler & R. Hagen

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  2. D. Ehrmann-Müller
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Interessenkonflikt

M. Scheich, D. Ehrmann-Müller, W. Shehata-Dieler und R. Hagen geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Scheich, M., Ehrmann-Müller, D., Shehata-Dieler, W. et al. Hörergebnisse nach transtemporaler Resektion kleiner (T1/T2) Akustikusneurinome. HNO 65, 751–757 (2017). https://doi.org/10.1007/s00106-016-0228-5

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