Objective: To evaluate the correlation between the vestibular branch of origin of the VS and post-operative hearing outcomes and facial nerve function in patients who underwent HPS by retrosigmoid approach. The secondary aim of this study was to examine the influence of other factors on the auditory prognosis, such as preoperative patient characteristics and radiological features of the neoplasm. Methods: A retrospective study was conducted on 31 patients who underwent SV exeresis via retrosigmoid approach. All patients were assessed preoperatively and postoperatively with audiometric examination. VII cranial nerve function was assessed by the House-Brackmann clinical scale (HB). The nerve of origin of the SV was established by intraoperative findings. Results: In our series, hearing preservation was achieved in 61.3% of patients and facial nerve function was preserved in 90.3% of patients. The intraoperative origin of the SV could not be found for 2 patients, while 61.3% of patients had SV arising from the inferior vestibular nerve and 32.3% from the superior vestibular nerve. Maintenance of an A or B class according to AAO-HNS occurred in 42.1% of patients with SV originating from inferior vestibular nerve and in 60% of patients with SV originating from superior vestibular nerve. The differences were not statistically significant. It was observed that all (100%) patients with impaired facial nerve function (HB = III at last follow-up) had SV arising from the superior vestibular nerve. It was found that the presence of cochlear symptoms at diagnosis correlated with a lack of hearing preservation. Conclusions: Our study shows no statistically significant correlation between a lack of hearing preservation and an intraoperative finding of SV arising from the inferior vestibular nerve. In accordance with the literature, a good rate of facial nerve preservation after HPS via RS approach was also found in our study, with more than 90% achieving HB I-II function at final follow-up. It was observed that a postoperative seventh cranial nerve deficit is significantly more frequent in patients with SV arising from superior vestibular nerve. The presence of cochlear symptoms at diagnosis correlated with a worse postoperative hearing outcome.
Scopo dello studio: Lo scopo principale di questo studio è stato valutare l’esistenza di una correlazione fra la funzionalità uditiva e la funzionalità del VII nervo cranico post-operatorie con la branca vestibolare di origine dello schwannoma vestibolare in pazienti trattati con HPS tramite approccio retrosigmoideo. L’obiettivo secondario è stato esaminare l’influenza di altri fattori sulla prognosi uditiva, come le caratteristiche preoperatorie del paziente e le caratteristiche radiologiche della neoplasia. Materiali e metodi: È stato condotto uno studio retrospettivo su 31 pazienti sottoposti ad exeresi di SV tramite approccio retrosigmoideo. Tutti i pazienti sono stati valutati preoperatoriamente e postoperatoriamente con esame audiometrico. La funzionalità del VII nervo cranico è stata valutata tramite la scala clinica di House-Brackmann (HB). Il nervo d’origine dello SV è stato stabilito in base al riscontro intraoperatorio. Risultati: Nel nostro campione il 61,3% dei pazienti ha preservato l’udito postoperatoriamente, mantenendo una classe uditiva A-B-C secondo AAO-HNS con SDS 100% e il 90,3% ha preservato la funzionalità del VII nervo cranico, mantenendo un grado I-II secondo HB. Per 2 pazienti non è stato possibile riscontrare l’origine intraoperatoria dello SV, mentre il 61,3% presentava SV originante dal nervo vestibolare inferiore e il 32,3% dal nervo vestibolare superiore. Il mantenimento di una classe A o B secondo AAO-HNS si è verificato nel 42,1% dei pazienti con SV originante dal nervo vestibolare inferiore e nel 60% dei pazienti con SV originante dal nervo vestibolare superiore. Le differenze non sono risultate statisticamente significative. Per quanto riguarda la correlazione fra nervo d’origine e funzionalità del VII nervo cranico, si è osservato che tutti (100%) i pazienti con funzionalità del facciale compromessa (HB III all’ultimo follow-up) presentavano uno SV originante dal nervo vestibolare superiore. Analizzando gli altri possibili fattori prognostici, si è riscontrato che la presenza di sintomatologia cocleare alla diagnosi è correlata con una mancata preservazione uditiva. Conclusioni: Dal nostro studio non emerge una correlazione statisticamente significativa fra una mancata preservazione uditiva e un riscontro intraoperatorio di SV originante dal nervo vestibolare inferiore. Per quanto riguarda gli outcome chirurgici sul nervo facciale, in accordo con quanto riportato in letteratura, anche nel nostro studio si è riscontrato un buon tasso di preservazione della funzionalità del nervo, con una percentuale maggiore del 90%. Si è osservato come un deficit del VII nervo cranico postoperatorio sia significativamente più frequente in pazienti con SV originanti dal nervo vestibolare superiore. La presenza di sintomatologia cocleare alla diagnosi risulta correlata ad un peggior outcome uditivo postoperatorio.
Valutazione del nervo d'origine dello schwannoma vestibolare ed influenze prognostiche nella chirurgia di preservazione dell'udito
ABBENITE, VALERIA
2022/2023
Abstract
Objective: To evaluate the correlation between the vestibular branch of origin of the VS and post-operative hearing outcomes and facial nerve function in patients who underwent HPS by retrosigmoid approach. The secondary aim of this study was to examine the influence of other factors on the auditory prognosis, such as preoperative patient characteristics and radiological features of the neoplasm. Methods: A retrospective study was conducted on 31 patients who underwent SV exeresis via retrosigmoid approach. All patients were assessed preoperatively and postoperatively with audiometric examination. VII cranial nerve function was assessed by the House-Brackmann clinical scale (HB). The nerve of origin of the SV was established by intraoperative findings. Results: In our series, hearing preservation was achieved in 61.3% of patients and facial nerve function was preserved in 90.3% of patients. The intraoperative origin of the SV could not be found for 2 patients, while 61.3% of patients had SV arising from the inferior vestibular nerve and 32.3% from the superior vestibular nerve. Maintenance of an A or B class according to AAO-HNS occurred in 42.1% of patients with SV originating from inferior vestibular nerve and in 60% of patients with SV originating from superior vestibular nerve. The differences were not statistically significant. It was observed that all (100%) patients with impaired facial nerve function (HB = III at last follow-up) had SV arising from the superior vestibular nerve. It was found that the presence of cochlear symptoms at diagnosis correlated with a lack of hearing preservation. Conclusions: Our study shows no statistically significant correlation between a lack of hearing preservation and an intraoperative finding of SV arising from the inferior vestibular nerve. In accordance with the literature, a good rate of facial nerve preservation after HPS via RS approach was also found in our study, with more than 90% achieving HB I-II function at final follow-up. It was observed that a postoperative seventh cranial nerve deficit is significantly more frequent in patients with SV arising from superior vestibular nerve. The presence of cochlear symptoms at diagnosis correlated with a worse postoperative hearing outcome.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/81489