청신경종양 환자에서 종양의 크기에 따른 임상양상, 청력 및 전정기능검사의 비교

이정엽,이세아,이상국,김정태,박승범,김보경,이종대 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.5

Background and Objectives Various hearing tests and vestibular function tests are used to diagnose acoustic neuroma. We analyzed the clinical characteristics and the results of audiovestibular function tests between patients of intrameatal and extrameatal acoustic neuroma. Subjects and Method Reviewing the medical records for 64 patients with acoustic neuroma between March 2007 and February 2014, we divided the patients into two groups, intrameatal (31 patients) and extrameatal acoustic neuroma (33 patients) according to the involvement of cerebropontine angle. We compared the clinical characteristics, pure tone audiograms, speech audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) between the two groups. Results While hearing loss was the most frequent presenting symptom in patients with intrameatal acoustic neuroma, dizziness was the most common symptom in patients with extrameatal acoustic neuroma. Hearing thresholds measured by pure tone audiometry and speech discrimination scores were significantly worse for patients with extrameatal acoustic neuroma. Abnormal unilateral canal paresis of caloric test was significantly higher for extrameatal acoustic neuroma than for intrameatal acoustic neuroma. Most patients with acoustic neuroma showed abnormal findings in the VEMP test, but the number of patients between intrameatal and extrameatal acoustic neuroma did not differ significantly. Conclusion Clinical symptoms and the results of audiovestibular function tests differed according to the tumor size of acoustic neuroma. Physicians should counsel patients presenting with audiovestibular symptoms of the possibility of acoustic neuroma. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(5):361-5

청신경종양에서 나타나는 청성뇌간반응 잠복기의 진단적 가치

박시영,신중욱,최정환 대한이비인후과학회 부산,울산,경남 지부회 2010 임상이비인후과 Vol.21 No.1

Background and Objectives:It is important to rule out acoustic neuroma when treating patients who have tinnitus or monaural hearing loss. The most accurate diagnostic tool is MRI but due to high costs, auditory brainstem response (ABR) latency is often used. The aim of this study is to confirm the diagnostic value of ABR latency in acoustic neuroma. Patients and Methods:The medical records of 20 patients who were diagnosed acoustic neuroma in MRI and evaluated with pure tone audiometry, speech audiometry and ABR were retrospectively reviewed from January, 2003 to January, 2010. Tumor size and hearing classification system of 2003 Consensus Meeting was used. Using I-V interpeak latency (IPL) and I-V interlatency difference (ILD), we identified the diagnostic value of ABR latency in diagnosing acoustic neuroma. Results:Among 20 patients, there were 2 cases of intrameatal tumor, 2 cases of grade 1, 6 cases of grade 2, 6 cases of grade 3, 2 cases of grade 4 and 2 cases of grade 5according to the acoustic neuroma classification system of 2003 Consensus Meeting. There were 9 cases with no wave in ABR. 4 cases showed over 4.4 msec in I-V IPL and 6 cases showed over 0.2 msec in I-V ILD. There were 3 cases that showed over 4.4 msec in I-V IPL and over 0.2 msec in I-V ILD. Therefore, there were 16 cases that showed abnormal reactions to ABR among acoustic neuroma patients, false negative rate was founded to 20%. Conclusion:The smaller tumor size, the better prognosis in treating tumor and preserving hearing and facial nerve function, so that early diagnosis of acoustic neuroma is important. Because false negative rate of ABR was 20% in this study, using ABR as screening test of acoustic neuroma needs attention.

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

Xiujue Zheng,Mantao Chen,Zuoxu Fan,Fei Cao,Liang Wang 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.3

Purpose: Many epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationshipbetween history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma. Materials and Methods: We searched PubMed to identify relevant articles. Two researchers evaluated the eligibility and extracted the data independently. Results: Eleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisurenoise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively. Conclusion: Our meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarettesmokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.

청신경종양에서 Vascular Endothelial Growth Factor의 발현

박진수(Jin Su Park),박무균(Moo Kyun Park),이종대(Jong Dae Lee),이원상(Won-Sang Lee) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.2

Objectives : VEGF(vascular endothelial growth factor) is a potent key mediator of angiogenesis, which is necessary during tumor growth. The goal of this study was to determine expression of VEGF in acoustic neuromas and to examine a correlation with clinical characteristics. Methods : The VEGF expression was evaluated by immunohistochemical staining with monoclonal anti-VEGF antibody in 25 cases of the acoustic neuromas. Results : All tumors showed expression of VEGF in cytoplasm of schwannoma cell. The staining density revealed an insignificant correlation between VEGF expression and tumor size, symptom duration. Conclusions : This study suggests that VEGF in acoustic tumor has a role of both angiogenesis and mitogenesis in the growth of schwannoma.

청신경종양 환자에서의 변조이음향방사 측정

김혁,윤태현,정종우,이광선 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.8

A Case of Gastric Cancer Manifesting as a Solitary Brain Metastasis in the Cerebellopontine Angle That Mimicked Acoustic Neuroma

주호연,채명훈,임주한,이현규,이문희,김철수,박영훈 전남대학교 의과학연구소 2013 전남의대학술지 Vol.49 No.3

At the time of diagnosis, about 20% of patients with gastric cancer have stage IV disease involving the liver, lung, and bone. Brain metastasis from gastric cancer is exceedingly rare, with an incidence of <1% of clinical cases. A 59-year-old man was admitted with hearing loss in the left ear and left facial palsy for 1 month. A magnetic resonance imaging scan revealed a tumor in the cerebellopontine angle that extended to the inner auditory canal and that was clinically diagnosed as acoustic neuroma. After complete resection,histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of the involvement of other sites except the brain parenchyma. Palliative total gastrectomy was performed and the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor. Here we report this rare case of gastric cancer that initially presented as a solitary brain metastasis mimicking acoustic neuroma.

에스상 정맥동 후방 접근법

이상원 ( Sang Won Lee ),성재훈 ( Jae Hoon Sung ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

The retrosigmoid approach is one of the most familiar approach for posterior fossa lesion. It can provide access from the foramen magnum to the tentorium but in order to avoid excessive cerebellar retraction and consequent contusion, its main focus is cerebellopontine angle(CPA) and posterolateral skull base. In this brief article, the authors point out important anatomic structures and stepwise operative considerations for removal of acoustic neuroma.

청신경종 제거수술 후 발생한 대뇌성 염소모 증후군

구용철,황치상,고승현,이원상 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.6

Cerebral Salt Wasting Syndrome (CSWS) is defined as the development of extracellular volume depletion due to a dysfunction of the renal sodium transport system. Differentiation of CSWS from the Symdrome of Inappropriate Secretion of Antidiuretic Hormone in patients with intracranial disease is difficult because both syndromes include hyponatremia and concentrated urine with natriuresis. However, distinguishing between these two syndromes is very important because the treatment options differ. We report a 41 year-old Asian woman who presented initially with hyponatremia, and was finally diagnosed with CSWS after an operation for an acoustic neuroma. Based on this case, we discuss a possible mechanism and disclose insights about differential diagnosis thereof.

발살바, 과호흡 유발안진

최광동 대한평형의학회 2010 Research in Vestibular Science Vol.9 No.-

central as well as peripheral vestibulopathies, including compensated peripheral vestibulopathies, perilymph fistula, acoustic neuroma, lesions at craniocervical junction, and cerebellar degeneration. A recent study documented that hyperventilation-induced nystagmus (HIN) beating to the side of reduced caloric response,hearing impairment, or abnormal auditory brainstem response may be a valuable sign for bedside detection of acoustic neuroma. Disruption of the central pathways compensating for a peripheral imbalance, increased neuronal excitability, changes in intracranial pressure, and metabolic changes on cerebellar calcium channels are potential mechanisms for the generation of HIN. The Valsalva maneuver may also produce vertigo and nystagmus in patients with craniocervical junction anomalies, perilymph fistula, and canal dehiscence syndromes. Presumably, Valsalva maneuver increases intracranial or tympanic pressure and exerts force directly at the site of the fistula or dehiscence, causing deflection of the cupula of the involved semicircular canal.

작은 청신경종양의 진단접근과정에 대한 연구

박기현,전영명,박홍준,이동훈 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.1