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摘要: 目的 本研究旨在分析单侧听神经瘤患者的听力和前庭功能测试结果，并探讨其与肿瘤大小之间的关系。方法 回顾性分析完成纯音听力测试(PTA)、颈性和眼性前庭肌源诱发电位(c/oVEMP)、视频头脉冲测试(vHIT)且经手术治疗的81例单侧听神经瘤患者的临床资料。根据增强MRI上肿瘤最大径将患者分为小肿瘤组(≤15 mm)、中等大小肿瘤组(16~30 mm)和大肿瘤组(>30 mm)。结果 PTA测试结果显示，73例(90.1%)患者出现听力受损；前庭功能测试结果显示，前半规管、水平半规管、后半规管、椭圆囊、球囊异常率分别为29.6%、77.8%、54.3%、90.1%和92.6%。经统计学分析，不同分组患者术前听力测试结果差异无统计学意义(F=0.393，P=0.676)，但水平半规管增益值(r=-0.248，P=0.025)，水平半规管扫视波异常率(r=0.507，P＜0.001)，cVEMP阈值(χ2=15.111，P=0.004)以及oVEMP阈值(χ2=18.948，P＜0.001)在不同大小肿瘤组之间差异有统计学意义。结论 听神经瘤患者的听力损失程度与肿瘤大小无关，但前庭功能的受损程度与肿瘤大小存在相关性。Abstract: Objective This study aimed to analyze the results of auditory and vestibular function tests in patients with unilateral vestibular schwannoma and explore their association with tumor size.Methods Clinical data from 81 patients diagnosed with unilateral vestibular schwannoma who underwent pure-tone audiometry(PTA), cervical and ocular vestibular evoked myogenic potentials(c/oVEMP), as well as video head impulse test(vHIT), and subsequently underwent surgical treatment, were retrospectively analyzed. Patients were categorized into groups based on tumor size: small (≤ 15 mm), medium(16-30 mm), and large (>30 mm), determined by the maximum tumor diameter on contrast-enhanced MRI scans.Results PTA results indicated hearing loss in 73 cases(90.1%); vestibular function tests revealed abnormal rates for the anterior semicircular canal, horizontal semicircular canal, posterior semicircular canal, utricle, and saccule at 29.6%, 77.8%, 54.3%, 90.1%, and 92.6%, respectively. Statistically, no significant differences were found in preoperative hearing test results among patients in different groups(F=0.393, P=0.676). However, significant differences were observed in horizontal semicircular canal gain(r=-0.248, P=0.025), abnormal rates of horizontal semicircular canal catch-up saccades(r=0.507, P < 0.001), as well as cVEMP(χ2=15.111, P=0.004) and oVEMP thresholds(χ2=18.948, P < 0.001) across varying tumor size groups.Conclusion The extent of hearing loss in patients with vestibular schwannoma is not correlated with tumor size, whereas the degree of vestibular dysfunction demonstrates a correlation with tumor size.
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表 1 不同分组听神经瘤患者人口统计学、主诉及术前听力的比较
基本资料 小肿瘤组
(n=20)中等大小肿瘤组
(n=41)大肿瘤组
(n=20)合计
(n=81)F/χ2/H P 年龄/岁 42.6±12.5 50.1±11.5 48.8±12.5 47.9±12.3 2.716 0.072 性别/例(%) 1.090 0.580 女 14(70.0) 23(56.1) 12(60.0) 49(60.5) 男 6(30.0) 18(43.9) 8(40.0) 32(39.5) 侧别/例(%) 0.314 0.855 左 11(55.0) 20(48.8) 11(55.0) 42(51.9) 右 9(45.0) 21(51.2) 9(45.0) 39(48.1) 主诉/例(%) 听力下降 19(95.0) 39(95.1) 18(90.0) 76(93.8) 0.672 0.715 耳鸣 19(95.0) 35(85.4) 16(80.0) 70(86.4) 1.996 0.369 头晕/眩晕 9(45.0) 18(43.9) 8(40.0) 35(43.2) 0.118 0.943 头痛 3(15.0) 7(17.1) 6(30.0) 16(19.8) 1.796 0.407 面部麻木/疼痛 1(5.0) 6(14.6) 4(20.0) 11(13.6) 1.996 0.369 耳闷 3(15.0) 6(14.6) 2(10.0) 11(13.6) 0.292 0.864 舌头麻木/味觉减退 0(0) 4(9.8) 2(10.0) 6(7.4) 2.126 0.345 听力下降 19(95.0) 39(95.1) 18(90.0) 76(93.8) 0.672 0.715 病程/年 1.0(0.3~2.0) 2.0(0.5~4.0) 2.0(1.0~5.5) 2.0(0.6~3.0) 4.779 0.092 术前PTA/dB 57.1±33.3 59.7±27.5 65.5±35.5 60.5±30.8 0.393 0.676 
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表 2 不同分组听神经瘤患者vHIT测试结果的比较
例(%) vHIT 小肿瘤组
(n=20)中等大小肿瘤组
(n=41)大肿瘤组
(n=20)合计
(n=81)F/χ2 P 前半规管 平均增益值 0.94±0.19 0.91±0.21 0.94±0.24 0.93±0.21 0.233 0.792 增益值异常 2(10.0) 8(19.5) 4(20.0) 14(17.3) 0.988 0.610 扫视波 4(20.0) 12(29.3) 8(40.0) 24(29.6) 1.924 0.382 水平半规管 平均增益值 0.80±0.31 0.74±0.20 0.62±0.14 0.72±0.23 3.357 0.040 增益值异常 5(25.0) 23(56.1) 18(90.0) 46(56.8) 17.234 < 0.001 扫视波 8(40.0) 35(85.4) 20(100.0) 63(77.8) 23.594 < 0.001 后半规管 平均增益值 0.92±0.14 0.84±0.21 0.82±0.20 0.86±0.20 1.569 0.215 增益值异常 1(5.0) 10(24.4) 6(30.0) 17(21.0) 4.349 0.114 扫视波 6(30.0) 27(65.9) 11(55.0) 44(54.3) 6.969 0.031
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表 3 不同分组听神经瘤患者VEMP测试阈值的比较
例(%) VEMP阈值 小肿瘤组
(n=20)中等大小肿瘤组
(n=41)大肿瘤组
(n=20)合计
(n=81)χ2 P cVEMP 15.111 0.004 阈值正常 4(20.0) 3(7.3) 0(0) 7(8.6) 阈值升高 8(40.0) 8(19.5) 1(5.0) 17(21.0) 无反应 8(40.0) 30(73.2) 19(95.0) 57(70.4) oVEMP 18.948 0.001 阈值正常 5(25.0) 3(7.3) 0(0) 8(9.9) 阈值升高 5(25.0) 2(4.9) 0(0) 7(8.6) 无反应 10(50.0) 36(87.8) 20(100.0) 66(81.5)
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表 4 不同分组听神经瘤患者cVEMP振幅不对称比的比较
例(%) cVEMP振幅不对称比 小肿瘤组
(n=18)中等大小肿瘤组
(n=36)大肿瘤组
(n=15)合计
(n=69)χ2 P 正常 < |±27%| 7(38.9) 4(11.1) 0(0) 11(15.9) 12.235 0.016 振幅减弱≥ 27% 10(55.6) 30(83.3) 15(100.0) 55(79.7) 振幅增强≥ 27% 1(5.6) 2(5.6) 0(0) 3(4.3)
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表 5 不同分组听神经瘤患者oVEMP振幅不对称比的比较
例(%) oVEMP振幅不对称比 小肿瘤组
(n=18)中等大小肿瘤组
(n=35)大肿瘤组
(n=13)合计
(n=66)χ2 P 正常 < |±27%| 5(27.8) 0(0) 0(0) 5(7.6) 20.881 < 0.001 振幅减弱≥ 27% 11(61.1) 35(100.0) 13(100.0) 59(89.4) 振幅增强≥ 27% 2(11.1) 0(0) 0(0) 2(3.0)
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