Contralateral hearing loss as an effect of venous congestion at the ipsilateral inferior colliculus after microvascular decompression: report of a case

Abstract

Contralateral hearing loss after surgical procedures within the cerebellopontine angle is rarely seen and its pathophysiological background is not yet understood. A patient with contralateral hearing loss after microvascular decompression for trigeminal neuralgia is described. Ipsilateral brainstem auditory potential (BAEP) monitoring and facial nerve EMG did not show major abnormalities. During otherwise uneventful and successful surgery a branch of the petrosal vein was sacrificed to widen the access to the trigeminal root exit zone. On the third postoperative day the patient complained about contralateral hearing loss, which was verified by audiometry. Contralateral BAEPs showed low amplitudes and delayed interpeak latencies. Brain CT was normal. Brain MRI on the 8th postoperative day disclosed abnormal signals within the ipsilateral inferior colliculus. Intravenous heparinisation was performed and hearing slowly recovered over a 3 month period. Results from this patient oVer a pathophysiological mechanism for contralateral hearing loss after cerebellopontine angle surgery, illustrate the importance of venous drainage preservation, gives evidence about the generation of BAEP components within the contralateral brainstem, and stresses the importance of intraoperative BAEP monitoring. (J Neurol Neurosurg Psychiatry 2000;69:679-682)

Case Study of Trigeminal Neuralgia Using Neurofeedback and Peripheral Biofeedback

“…The next consideration is surgery consisting of the following choices: microvascular decompression (Tyler-Kabara et al, 2002;Barker, Jannetta, Bissonette, Larkins, & Jho, 1996), nerve injury/destructive procedures (rhizotomies) including percutaneous glycerol rhizotomy, percutaneous balloon compression rhizotomy (Skirving & Dan, 2001), radiofrequency rhizotomy, stereotactic radiosurgery-gamma knife (Pollock et al, 2000;Kao, 2002), peripheral trigeminal nerve blocks, sectioning and avulsions and microsurgical rhizotomy. These choices carry the following risks: (a) general and frequent occurrence of facial numbness, sometimes permanent, (b) loss of sensation to the cornea that can lead to blindness (Egan, Pless, & Shults, 2001), (c) loss of hearing (Strauss, Naraghi, Bischoff, Huk, & Romstock, 2000), (d) loss of chewing strength on the side of treatment (Yoon, Wiles, Miles, & Nurmikko, 1999), and (e) the general risks of surgery, post-operative infection, stroke, bleeding and swelling (Kaufmann & Patel, 2001;Brisman, 2002). Alternative treatments such as acupuncture have had mixed results across the spectrum of TN sufferers, but it has resulted in pain relief for some (Beppu, Sato, Amemiya, & Tode, 1992).…”

Auditory and Electrophysiological Patterns of a Unilateral Lesion of the Lateral Lemniscus

“…It was attributed to an ipsilateral venous congestion of the right inferior colliculus, as detected by MRI. However, puretone audiometry and BAEPs were not suggestive of a col-Cho/Fischer/Nighoghossian/Hermier/ Sindou/Mauguière licular lesion, but rather pointed to a postoperative dysfunction at the cerebellopontine angle level: elevated hearing thresholds and absence of waves I and III, with a delayed wave V [Strauss et al, 2000].…”

“…Unilateral lesions of the inferior colliculus are even rarer Fischer et al, 1995]: contralateral anomalies were observed (diminished and delayed wave V, extinction on dichotic testing), without any spontaneous auditory complaint. Strauss et al [2000] reported a contralateral (left) hearing loss after surgery for a trigeminal neuralgia. It was attributed to an ipsilateral venous congestion of the right inferior colliculus, as detected by MRI.…”

Contralateral Hearing Disturbance Following Posterior Fossa Surgery -Case Report-

“…This severe complication is also known to occur in other posterior fossa surgery. [3][4][5]7,9,10,[12][13][14]17,18,20,21) We describe a rare case of contralateral hearing disturbance after acoustic neuroma surgery.…”

“…20) This complication can also occur in other posterior fossa procedures for meningioma, 20) epidermoid, 5,10,13) chordoma, 10) and microvascular decompression for trigeminal neuralgia 12,17) ( Table 2). Occurrence of contralateral hearing disturbance Neurol Med Chir (Tokyo) 51, June, 2011…”