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

Butler, Margaret J; Wick, Cameron C.; Shew, Matthew; Chicoine, Michael R.; Ortmann, Amanda; Vance, Janet; Buchman, Craig A.

doi:10.1093/ons/opab274

Cited by 11 publications

(7 citation statements)

References 57 publications

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“…If surgery is recommended, the decision of devices is more nuanced given the potential for nerve disruption. Using a commercial CI, one can measure both evoked auditory brainstem response and stapedial reflexes, which may provide an intraoperative assessment of cochlear nerve integrity (10,26,27). For patients implanted after surgery, transtympanic promontory stimulation testing may be an option for testing cochlear nerve integrity (28).…”

Section: Discussionmentioning

confidence: 99%

Comparing Speech Recognition Outcomes Between Cochlear Implants and Auditory Brainstem Implants in Patients With NF2-Related Schwannomatosis

Dornhoffer,

Plitt,

Lohse

et al. 2023

Otol Neurotol

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Objective To compare cochlear implant (CI) and auditory brainstem implant (ABI) performance in patients with NF2-related schwannomatosis (NF2) Study Design Historical cohort. Setting Tertiary academic center. Patients A total of 58 devices among 48 patients were studied, including 27 ABIs implanted from 1997 to 2022 and 31 CIs implanted from 2003 to 2022. Three patients had bilateral ABIs, three had bilateral CIs, three had an ABI on one side and a CI on the other, one had a CI that was later replaced with an ipsilateral ABI, and one had an ABI and CI concurrently on the same side. Interventions CI or ABI ipsilateral to vestibular schwannoma. Main Outcome Measures Open-set speech perception, consonant-nucleus-consonant word scores, and AzBio sentence in quiet scores. Results Among all patients, 27 (47%) achieved open-set speech perception, with 35 (61%) daily users at a median of 24 months (interquartile range [IQR], 12–87 mo) after implantation. Comparing outcomes, CIs significantly outperformed ABIs; 24 (77%) CIs achieved open-set speech perception compared with 3 (12%) ABIs, with median consonant-nucleus-consonant and AzBio scores of 31% (IQR, 0–52%) and 57% (IQR, 5–83%), respectively, for CIs, compared with 0% (IQR, 0–0%) and 0% (IQR, 0–0%), respectively, for ABIs. Patients with ABIs were younger at diagnosis and at implantation, had larger tumors, and were more likely to have postoperative facial paresis. Conclusion Many patients with NF2-associated vestibular schwannoma achieved auditory benefit with either a CI or an ABI; however, outcomes were significantly better in those patients who were able to receive a CI. When disease and anatomy permit, hearing rehabilitation with a CI should be considered over an ABI in these patients. Tumor management strategies that increase the ability to successfully use CIs should be strongly considered given the high risk of losing bilateral functional acoustic hearing in this population.

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Section: Discussionmentioning

confidence: 99%

Comparing Speech Recognition Outcomes Between Cochlear Implants and Auditory Brainstem Implants in Patients With NF2-Related Schwannomatosis

Dornhoffer,

Plitt,

Lohse

et al. 2023

Otol Neurotol

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“…This technique has been suggested to best preserve the cochlear nerve during tumor resection for continued successful implant use. 26,27…”

Section: Discussionmentioning

confidence: 99%

“…If surgery is needed, some data suggest that the implant may be used for intraoperative auditory brainstem response and neural response imaging for cochlear nerve monitoring. This technique has been suggested to best preserve the cochlear nerve during tumor resection for continued successful implant use 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…This technique has been suggested to best preserve the cochlear nerve during tumor resection for continued successful implant use. 26,27 The present report is unique in reviewing hearing outcomes only in patients with observed VS. Our findings have bolstered our confidence in the feasibility of serial imaging for patients with VS and ipsilateral CI. Furthermore, hearing outcomes in this patient population have been favorable.…”

Section: Treatment Postimplantationmentioning

confidence: 96%

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Cochlear Implantation Outcomes in Observed Vestibular Schwannoma: A Preliminary Report

Longino¹,

Manzoor²,

Cass³

et al. 2021

Otolaryngol.--head neck surg.

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Objective Over the last decade there has been a trend toward observation for small nongrowing vestibular schwannoma (VS). Even without tumor growth, patients commonly experience ipsilateral hearing decline, and hearing rehabilitation remains challenging. This study analyzes hearing and speech performance outcomes after cochlear implantation (CI) in observed VS. Study Design Retrospective review. Setting Tertiary referral center. Methods Chart review was used to include patients with observed VS who had undergone ipsilateral CI, pre- and postimplantation audiometry, and speech performance. Tumor size pre- and postimplantation was measured with volumetric analysis. Results Seven patients with ipsilateral VS and CI were identified. Preimplantation tumor volume was 0.11 to 1.02 cm3. Five subjects were implanted with a straight electrode and two with a perimodiolar electrode. The average preimplant pure tone average was 91.3 dB (range, 80-117 dB) and 61.2 dB (range, 12-118 dB) for the implanted and nonimplanted ears, respectively. In all subjects with at least 1 year of listening experience (n = 6), consonant-nucleus-consonant word scores improved at 6 months and 1 year in the CI-alone and bimodal listening conditions. AzBio scores in quiet also improved at 6 months and 1 year. Of subjects with serial pre- and postoperative magnetic resonance imaging, volumetric analysis demonstrated no tumor growth. Conclusion Our results demonstrate that CI is a successful option for subjects with small nongrowing VS. All subjects had improved performance postimplantation. VS may continue to be observed with serial magnetic resonance imaging given increasing conditionality among CI manufacturers and ability to assess cerebellopontine angle extension despite implant artifact.

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“…The use of conventional measures such as auditory-evoked auditory brainstem response (ABR) or cochlear nerve action potentials has limited utility in patients with poor baseline hearing and cannot be used to monitor cochlear nerve integrity with the translabyrinthine approach, where acoustic hearing is necessarily lost during labyrinthectomy. Recent studies have demonstrated the utility of electrically evoked auditory brainstem response (eABR) and streaming neural response telemetry (NRT) for intraoperative monitoring of the cochlear nerve with a commercial cochlear implant system or a test electrode and have shown increased accuracy in predicting CI performance after VS resection (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Use of Electrical Stapedius Reflex Testing for Cochlear Nerve Monitoring During Simultaneous Translabyrinthine Resection of Vestibular Schwannoma and Cochlear Implantation

Kocharyan

Daher

Nassiri

et al. 2022

Otology &Amp; Neurotology

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Objective: To report the novel use of intraoperative electrically evoked stapedial reflex (eSR) for cochlear nerve monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation. Study Design: Clinical capsule report with video demonstration. Setting: Tertiary academic referral center. Patient: A 58-year-old female presented with a small right intracanalicular VS with associated asymmetrical right moderate to severe sensorineural hearing loss, poor word recognition, tinnitus, and disequilibrium. Based on patient symptomatology and goals, simultaneous CI with translabyrinthine resection of the VS was performed. Intervention: Cochlear implantation before the tumor was resected facilitated intraoperative eSRs by delivering repeated single-electrode stimulations through the cochlear implant (CI) electrode during tumor resection. A pulse duration of 50-us and a current amplitude of 200-CL or 648-us was used to elicit eSRs visible through the facial recess. Intraoperative eSR was monitored in conjunction with electrically evoked compound action potentials via neural response telemetry and electrical auditory brainstem response. Results: Despite the transient evoked compound action potentials amplitude and electrical auditory brainstem response latency changes, the visually observed eSR was preserved and remained robust throughout tumor dissection, indicating an intact cochlear nerve. Four weeks postoperatively, the patient exhibited open-set speech capacity (14% CNC and 36% AzBio in quiet). Conclusion:The current study demonstrates the feasibility of using intraoperative eSR via a CI electrode to monitor cochlear nerve integrity during VS resection, which may indicate successful CI outcomes. These preliminary findings require further substantiation in a larger study.

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

Cited by 11 publications

References 57 publications

Comparing Speech Recognition Outcomes Between Cochlear Implants and Auditory Brainstem Implants in Patients With NF2-Related Schwannomatosis

Comparing Speech Recognition Outcomes Between Cochlear Implants and Auditory Brainstem Implants in Patients With NF2-Related Schwannomatosis

Cochlear Implantation Outcomes in Observed Vestibular Schwannoma: A Preliminary Report

Intraoperative Use of Electrical Stapedius Reflex Testing for Cochlear Nerve Monitoring During Simultaneous Translabyrinthine Resection of Vestibular Schwannoma and Cochlear Implantation

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