Akustik Nörinom Cerrahisi
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Dosyalar
Tarih
2003
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Akustik nörinom tedavisindeki yaklaşımlarımızı sunmak ve sonuçlarımızı değerlendirmek. Hastalar ve Yöntemler: Akustik nörinom tanısı alan 13 olgu dosyaları retrospektif olarak incelenerek bu çalışma kapsamına alındı. Olgular tam bir nöro-otolojik muayene yanında, odiyolojik testler (pür tone odiogram, akustik empedans), ABR, kalorik test, bilgisayarlı tomografi (BT) ve/veya magnetik resonans görüntüleme (MRG) ile değerlendirildiler. Olgulardan 10’una cerrahi (5 translabirentin, 4 suboksipital, 1 transotik) tedavi uygulanırken, 3’ünde tümör seri MRG incelemeleri ile takibe alındı. Bulgular: Olguların 8’sı kadın, 5’ü erkek ve ortalama yaş 40.3 idi. Olguların %84.6’sında tek taraflı nörosensoriyal işitme kaybı, %53.8’inde tinnitus mevcuttu. Bir olgu ani işitme kaybı (%7.7) ile kliniğimize müracaat etti. Kalorik testte, olguların %69.2’sinde vestibüler cevap azalmış olarak belirlendi. 40 mm’den büyük tümörlerde subtotal rezeksiyon (%20) yapılabilirken, diğer tümörler total (%80) olarak çıkarıldı. Bir olguda, fasiyal sinir bütünlüğü korunamadı, uc uca sinir anastomozu ile rekonstrüksiyon yapıldı. Beyin omurilik sıvısı (BOS) fistülü bir olguda (%10) gelişti. Subtotal rezeksiyon yapılan olgular, düzenli olarak alınan MRG incelemeleriyle takip edildi ve tümörde belirgin bir hacim artışı görülmedi. Total rezeksiyon yapılan olgularımızda 58.6 ay (10-119 ay) olan ortalama takip süresinde nüks belirlenmedi. Operasyonu kabul etmediği için periyodik MRG takibine alınan 3 olguda ise ortalama 21 aylık takip süresinde tümör boyutunda artışa ait bir bulgu tesbit edilmedi. Sonuç: Akustik nörinom tedavisinde cerrahi yaklaşım belirlenirken, tekniğin residü tümör bırakma ve fasiyal siniri zedelenme potansiyeli değerlendirilmelidir. Translabirentin yaklaşım, total tümör rezeksiyonu ve fasiyal sinirin korunması açısından en uygun tekniktir.
Objectives: To present our approaches for acoustic tumor treatment and evaluate the results. Patients and Methods: Thirteen cases with acoustic tumor have been included in this study. All cases were evaluated with complete neuro-otologic examination. Audiometric tests (pure-tone audiogram, acoustic impedance, auditory brainstem response audiometry), magnetic resonance imaging (MRI) and/or CT scan, and caloric tests were also performed. Ten patients were treated surgically and the remainin three patients were followed by MRI to monitor tumor growth. Results: Eight of the cases were female and five of them were male. The average age was 40.3. 84.6% of the cases had unilateral hearing loss, 53.8% had tinnitus and 7.7% had sudden hearing loss as the presenting symptom. Caloric responses were decreased in the effected ears in %69.2 of the cases. Tumors larger than 40 mm could be resected subtotally (%20), the others were removed completely (80%). In one case, the facial nerve could not be saved and a re-innervation procedure was performed by end-to-and nerve anastomosis. Cerebrospinal fluid fistula developed in one case (10%). The patients, in whom tumor removal was incomplete, were followed up with MRI and none of them showed increase in the size of the tumor. The patients in whom total resection was achieved, no recurrence was detected in the mean follow-up period of 58.6 months (range: 10-119 months). The size of the tumor in MRI showed no increase in three cases who were not treated surgically, in the mean follow-up period of 21 months. Conclusion: One should revise each technique for the risks of leaving residual tumor and trauma to the facial nerve, when deciding for the most appriopriate approach in the surgical treatment of an acoustic neurinoma. In our experience, the translabyrinthine approach provides satisfactory results, in terms of total tumor removal and facial nerve preservation.
Objectives: To present our approaches for acoustic tumor treatment and evaluate the results. Patients and Methods: Thirteen cases with acoustic tumor have been included in this study. All cases were evaluated with complete neuro-otologic examination. Audiometric tests (pure-tone audiogram, acoustic impedance, auditory brainstem response audiometry), magnetic resonance imaging (MRI) and/or CT scan, and caloric tests were also performed. Ten patients were treated surgically and the remainin three patients were followed by MRI to monitor tumor growth. Results: Eight of the cases were female and five of them were male. The average age was 40.3. 84.6% of the cases had unilateral hearing loss, 53.8% had tinnitus and 7.7% had sudden hearing loss as the presenting symptom. Caloric responses were decreased in the effected ears in %69.2 of the cases. Tumors larger than 40 mm could be resected subtotally (%20), the others were removed completely (80%). In one case, the facial nerve could not be saved and a re-innervation procedure was performed by end-to-and nerve anastomosis. Cerebrospinal fluid fistula developed in one case (10%). The patients, in whom tumor removal was incomplete, were followed up with MRI and none of them showed increase in the size of the tumor. The patients in whom total resection was achieved, no recurrence was detected in the mean follow-up period of 58.6 months (range: 10-119 months). The size of the tumor in MRI showed no increase in three cases who were not treated surgically, in the mean follow-up period of 21 months. Conclusion: One should revise each technique for the risks of leaving residual tumor and trauma to the facial nerve, when deciding for the most appriopriate approach in the surgical treatment of an acoustic neurinoma. In our experience, the translabyrinthine approach provides satisfactory results, in terms of total tumor removal and facial nerve preservation.
Açıklama
Anahtar Kelimeler
Kulak, Burun, Boğaz, Akustik nörinom, Tedavi, Cerrahi, Acoustic neurinoma, Treatment, Surgery
Kaynak
KBB-Forum
WoS Q Değeri
Scopus Q Değeri
Cilt
2
Sayı
1
Künye
Ülkü, Ç. H., Uyar, Y., Özkal, E., Acar, O., Kocaoğulları, Y., (2003). Akustik Nörinom Cerrahisi. KBB-Forum, 2(1), 11-16.
