Hearing Restoration During Vestibular Schwannoma Surgery With Transcanal Approach: Anatomical and Functional Preliminary Report

Marchioni, Daniele; Veronese, Sheila; Carner, Marco; Sacchetto, Andrea; Sacchetto, Luca; Masotto, Barbara; Bianconi, Luca

doi:10.1097/mao.0000000000001980

Cited by 14 publications

(6 citation statements)

References 24 publications

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“…11 For small acoustic neuromas confined to the internal auditory meatus, the scala tympani is retained when opening and exposing the cochlea middle turn and top turn. 12 Using our surgical approach, we also found that we did not need to open and expose the cochlea middle turn and top turn, and we avoided damage to the residual hearing of the cochlea by extending the vestibular window and grinding part of the promontorium tympani. We removed the acoustic neuromas directly through the internal auditory meatus.…”

Section: Discussionmentioning

confidence: 87%

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

Chen

Zhou

et al. 2021

J Int Med Res

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We evaluated the outcomes of resection of small acoustic neuromas using the transcanal transvestibular endoscopic approach. Two patients with a small acoustic neuroma were treated using this approach. The sizes of the tumors were 11 × 6 mm and 12 × 10 mm. Both tumors were removed completely without residual tumor tissue, and damage to the facial nerve and cochlear nerve was avoided. No patients developed postoperative vertigo, aggravation of postoperative facial paralysis, severe pain, or permanent postoperative complications. The patients were followed up for 6 months, and none developed recurrence. Resection of small acoustic neuromas by the transcanal transvestibular endoscopic approach is a simple and safe technique that achieves excellent functional results.

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Section: Discussionmentioning

confidence: 87%

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

Chen

Zhou

et al. 2021

J Int Med Res

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“…4,19 While commonly used for resection of cholesteatoma and tympanoplasty, the endoscope has also been successfully utilized to resect ILS and ensure macroscopic clearance of disease. 4,8,12,20 Pan and colleagues 4 reported an endoscopic-assisted resection of an ILS in 2019. This was followed by Ma et al, 8 who in 2020 reported an endoscopic-assisted resection of ICS followed by immediate cochlear implantation.…”

Section: Discussionmentioning

confidence: 99%

Resection of Intracochlear Schwannomas With Immediate Cochlear Implantation

Patel

Fleischer

Wiet

et al. 2022

Ann Otol Rhinol Laryngol

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Introduction: Intralabyrinthine schwannomas, including the intracochlear variety, are rare benign tumors. They can cause a number of symptoms and have the potential to grow to involve other critical structures of the inner ear and skull base. While surgical resection is feasible, there is typically permanent hearing dysfunction as a result of resection and subsequent fibrosis. Here, we present 2 cases of intracochlear schwannomas (ICS) that were successfully resected with simultaneous cochlear implant placement. Methods: Patient 1 presented with an intravestibulocochlear schwannoma. This patient underwent a translabyrinthine approach. Endoscopic assistance was used to dissect the tumor from the vestibule and basal turn of the cochlea, through an enlarged round window approach. A cochlear implant was placed via a round window cochleostomy. Patient 2 presented with an intracochlear schwannoma involving the basal and middle turns of the cochlea. The patient underwent a trans-otic approach for resection. A large portion of the cochlear promontory required unroofing for complete exposure of the tumor. A cochlear implant was then placed via a round window cochleostomy. Results: Upon cochlear implant activation, Patient 1’s sound field thresholds using the implant were near the normal range of hearing, ranging from 25 to 50 dB HL from 250 to 6000 Hz. Patient 2’s 6-month post-operative cochlear implant sound field testing ranged from 20 to 30 dB HL from 250 to 6000 Hz and speech recognition testing revealed 59% on AZ Bio sentences compared to 0% pre-operatively. Conclusion: Simultaneous cochlear implantation after resection of intracochlear schwannomas is safe and successful in restoring hearing. Attention to adequate exposure and endoscopic assistance, when required, allow for gross total resection while minimizing trauma to cochlear structures. In such cases, immediate cochlear implantation allows for hearing rehabilitation before likely cochlear fibrosis can occur.

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“…18,23,47 Optimizing CI rehabilitation has potential to help the NF2 population. 25,[48][49][50][51][52][53][54][55] Still, caution should be advised when patients have a large tumor burden. Future data on patient quality of life and long-term outcomes are needed before this approach can be more broadly accepted.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series

Butler¹,

Wick²,

Shew³

et al. 2021

Operative Surg.

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BACKGROUND Neurofibromatosis type 2 (NF2) often results in profound hearing loss and cochlear implantation is an emerging hearing rehabilitation option. However, cochlear implant (CI) outcomes in this population vary, and intraoperative monitoring to predict cochlear nerve viability and subsequent outcomes is not well-established. OBJECTIVE To review the use of intraoperative electrically evoked cochlear nerve monitoring in patients with NF2 simultaneous translabyrinthine (TL) vestibular schwannoma (VS) resection and cochlear implantation. METHODS A retrospective review was performed of 3 patients with NF2 that underwent simultaneous TL VS resection and cochlear implantation with electrical auditory brainstem response (eABR) measured throughout tumor resection. Patient demographics, preoperative assessments, surgical procedures, and outcomes were reviewed. RESULTS Patients 1 and 3 had a reliable eABR throughout tumor removal. Patient 2 had eABR pretumor removal, but post-tumor removal eABR presence could not be reliably determined because of electrical artifact interference. All patients achieved auditory percepts upon CI activation. Patients 1 and 2 experienced a decline in CI performance after 1 yr and after 3 mo, respectively. Patient 3 continues to perform well at 9 mo. Patients 2 and 3 are daily users of their CI. CONCLUSION Cochlear implantation is attainable in cases of NF2-associated VS resection. Intraoperative eABR may facilitate cochlear nerve preservation during tumor removal, though more data and long-term outcomes are needed to refine eABR methodology and predictive value for this population.

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Hearing Restoration During Vestibular Schwannoma Surgery With Transcanal Approach: Anatomical and Functional Preliminary Report

Abstract: Transcanal retrocochlear approach for VS removal allows preservation of cochlea and cochlear nerve function. This is the first step towards developing an effective surgical technique for VS removal and hearing rehabilitation with CI.

Cited by 14 publications

References 24 publications

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

Resection of Intracochlear Schwannomas With Immediate Cochlear Implantation

Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series

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