复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Acoustic neuroma

Acoustic neuroma Chunfu dai m,d ph. d

Acoustic neuroma Chunfu Dai M.D & Ph.D

Background Originate from vestibular branch of acoustic nerve Histologic feature schwannoma neuroma, neurolemmoma Predilection :30-50 Unilateral: majority Bilateral: Type II acoustic neuroma

Background ◼ Originate from vestibular branch of aucoustic nerve ◼ Histologic feature: schwanoma, neuroma, neurolemmoma ◼ Predilection: 30-50y ◼ Unilateral: majority ◼ Bilateral: Type II acoustic neuroma

Pathology Predominate, internal auditory canal Extension to CPA Compression on brainstem and brain hydrops Anterior trigeminal nerver Medial: abducent nerve Inferior:ⅨXXI,XI

Pathology ◼ Predominate: internal auditory canal ◼ Extension to CPA ◼ Compression on brainstem and brain hydrops ◼ Anterior: trigeminal nerve, ◼ Medial: abducent nerve ◼ Inferior: IX, X, XI, XII

Clinical presentations Hearing loss and tinnitus Progressive HL 90% SDS reduction 10% of patients complain of sudden HL Unbalance Otalgia and compression due to depression of sensor fiber of facial nerve Involvement of trigeminal nerve Compression of cerebellum and brainstem ataxia, nystagmus and intracranial hypo- pressure

Clinical presentations ◼ Hearing loss and tinnitus ◼ Progressive HL 90% ◼ SDS reduction ◼ 10% of patients complain of sudden HL. ◼ Unbalance ◼ Otalgia and compression due to depression of sensor fiber of facial nerve ◼ Involvement of trigeminal nerve ◼ Compression of cerebellum and brainstem: ataxia, nystagmus and intracranial hypo￾pressure

Work-up Audiometry PTA: threshold elevated in high frequency a tone decay test: positive Speech audiometry u Acoustic impedance ABR: latency of wave V prolongs, or wave V disappears Acoustic emission

Work-up ◼ Audiometry ◼ PTA: threshold elevated in high frequency ◼ tone decay test: positive ◼ Speech audiometry ◼ Acoustic impedance ◼ ABR: latency of wave V prolongs, or wave V disappears ◼ Acoustic emission

Work-up Vestibular function Neurologic exam Image study 口 CT shows enlargement of internal auditory canal MRI

Work-up ◼ Vestibular function: ◼ Neurologic exam ◼ Image study ◼ CT shows enlargement of internal auditory canal ◼ MRI

Managements u Surgery Middle cranionectomy useful hearing Translabyrinectomy a no useful hearing Nice exposure of facial nerve

Managements ◼ Surgery ◼ Middle cranionectomy: useful hearing ◼ Translabyrinectomy: ◼ no useful hearing ◼ Nice exposure of facial nerve

Managements i Retro-sigmoid sinus approach Inferior occipital approach Big tumor >3cm Nice exposure tumor

Managements ◼ Retro-sigmoid sinus approach: ◼ Inferior occipital approach: ◼ Big tumor >3cm ◼ Nice exposure tumor

Managements No surgical intervention y-Knire a observation

Managements ◼ No surgical intervention ◼ -Knife ◼ observation