聽神經瘤的形態與耳科學檢查結果之關係

Correlations Between Morphology of Acoustic Neuroma and Otological Manifestations

吳辰龍(Cheng-Lung Wu) ； 林鴻清(Hung-Ching Lin) ； 徐銘燦(Min-Tsan Shu) ； 張克昌(Ke-Chang Chang)

《中華民國耳鼻喉科醫學會雜誌》 33卷4期 (1998/08) Pp. 297-304

https://doi.org/10.6286/1998.33.4.297

摘要

背景：聽神經瘤的形態會因為腫瘤的位置與腫瘤的大小而有所不同，它的形態與各種耳科學檢查結果的關係，是本研究探討的主題。
方法：21名聽神經瘤的患者，依其電腦斷層或磁振影像上腫瘤的位置，分為外側型腫瘤（3例，14.3%）、中間型腫瘤（9例，42.8%）與內側型腫瘤（9例，42.8%）三組。又依腫瘤的大小，階倫小腫瘤（2例，9.5%），中腫瘤（10例，47.6%）與大腫瘤（9例，42.9%）三組。患者之臨床症狀及各種耳科學檢查的結果均加以記錄。
結果：經分析發現具顯著差異者如下：1)外側型聽神經瘤多為小腫瘤，內側型聽神經瘤則多為大腫瘤。2)身體不平衡與頭痛的症狀較常出現在大聽神經瘤，少出現在小聽神經瘤。3)X光Stenvers投影的結果在內側型聽神經瘤全部為正常，而在外側型與中間型聽神經瘤則多為不正常。而各種耳科學檢查對診斷聽神經瘤的靈敏度分別如下：聽反射閾檢查85%（其中55%為聽反射消失，30%為聽反射閾值異常）；聽反射衰退檢查15%；X光Stenvers投影52.6%；聽性腦幹反應檢查100%。
結論：我們認為，某些症狀的出現（例如身體不平衡、頭痛、突發性耳聾等），似乎可大致猜測神經瘤的形態；此外，最好同時施行多種的耳科學檢查，不能增加診斷聽神經瘤的靈敏度，尤其是聽性腦幹反應檢查。

關鍵字

聽神經瘤

並列摘要

Background: Twenty-one patients with acoustic neuroma were studied to determine whether different types of neuroma could be correlated with specific signs, symptoms or otological manifestations.
Methods: Based on CT or MRI results, 21 cases of acoustic neuroma could be divided into three groups, either by size (small: 9.5%, meduium: 47.6%, and large: 42.9%) or by site of origin of the tumor (lateral: 14.3%, intermediate: 42.8%, and medial: 42.8%). Relations were studied between the size and the site of origin of the tumor and clinical and otological findings.
Results: Patients with lateral neuromas generally had smaller tumors while patients with medial neuromas had larger tumors. Unsteadiess was noted more often in patients with large neuromas than those with small or medium neuromas. High tone hearing loss was the most frequent presentation in pure tone audiometry of these 21 patients. The sensitivity of acoustic reflex threshold (ART) test was 85%, and more than half of the abnormal group were presented with the type IV ART pattern. Stenver’s projection of X-ray was noted more sensitive in patients with larteral neuromas, while in showed a 100% false negative rate. The sensitivity of the brainstem evoked potentials (BAEPs) was 100%; however, abnormalities in the BAEPs did not seem to be related to either the size or the site of origin of the tumor.
Conclusions: Some specific otological manifestations seem to be correlated with specific morphology of acoustic neuromas. In addition, combining 2 or more otological data can improve the sensitivity rate in detecting acoustic tumors; especially when BAEPs abnormalities being considered insignificant at the presence of profound hearing loss.

並列關鍵字

acoustic neuroma