Objective: To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. Study Design: Retrospective study. Method: The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. Result: Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p< 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p< 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. Conclusions: Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.
目的：分析手术治疗的鼓室乳突副神经节瘤患者长期面神经功能及总体术后状况。研究设计：回顾性研究。方法：系统评估1983年至2023年间接受手术治疗的A类和B类鼓室乳突副神经节瘤患者的医疗记录。结果：本中心共手术治疗213例鼓室乳突副神经节瘤。患者平均年龄54岁，男女比例为1:6。就诊时最常见症状为听力下降（80%）、搏动性耳鸣（77%）和眩晕（15%）。根据改良Fisch分型，45%病例为A类（A1和A2型），55%为B类（B1、B2和B3型）。所有A类及大多数B1、B2型肿瘤均经耳道内或耳后-耳道联合入路切除，而更晚期的B3型病变则采用岩骨次全切除联合中耳填塞术。所有A类和B类病例面神经功能预后良好，但术后麻痹风险随肿瘤体积和范围扩大略有增加（p<0.05）。A1、A2、B1及B2型肿瘤听力预后良好，而更晚期的B3型病例存在气导听力损失和骨导阈值升高（p<0.05）。97%病例实现肿瘤完全切除。最常见的远期并发症为永久性鼓膜穿孔（7%），复发率为3%。结论：鼓室乳突副神经节瘤是中耳腔最常见的肿瘤。搏动性耳鸣和听力下降是最常见的就诊症状，而所有病例在初次耳镜检查时均可见鼓室后肿物。面神经功能记录和听力学评估是术前检查的关键环节。高分辨率计算机断层扫描（HRCT）是首选的术前影像学检查，而磁共振成像（MRI）联合或不联合钆增强则用于评估颈动脉或颈静脉球受累的疑难病例。鼓室乳突副神经节瘤治疗的主要目标是彻底切除病灶并保留听力和面神经功能。手术治疗仍是首选方案，具有完全切除病灶、较低复发率和并发症发生率以及可接受的术后听力水平等优势。本文呈现了我们40年的诊疗经验，据我们所知，这是英文文献中最大系列的鼓室乳突副神经节瘤病例报道。
Long-Term Surgical Outcome of Class A and B Tympanomastoid Paragangliomas
肿瘤(癌症)患者之家