Preservation of Hearing in Large Acoustic Neurinomas Following Removal via Suboccipito-Lateral Approach

Fahlbusch, Rudolf; Neu, Mandana; Strauß, Christian

doi:10.1007/s007010050178

Cited by 43 publications

(19 citation statements)

References 23 publications

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“…1,3,5,6,21,23,27 In surgery for acoustic neuromas, EMG neuromonitoring has become a routine tool used to identify and protect the seventh cranial nerve; however, additional postoperative facial paresis has been reported in 10 to 27% of cases, especially following excision of large tumors. 7,18,19,28,29,31 The rate of anatomical and functional preservation of the facial nerve was significantly lower in the era before standard EMG monitoring was applied routinely.…”

mentioning

confidence: 99%

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

Romstöck¹,

Strauß²,

Fahlbusch³

2000

Journal of Neurosurgery

243

117

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It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

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mentioning

confidence: 99%

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

Romstöck¹,

Strauß²,

Fahlbusch³

2000

Journal of Neurosurgery

243

117

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“…6,30,32,50,51,56,62,77,78,86,92 Glasscock and others submitted that no patient should be excluded from surgery based on tumor size alone. 7,36,55,97 Several groups have supported this position, declaring that aggressive tumor removal as early as possible provides the greatest chance of hearing preservation.…”

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confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

260

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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“…Recently, hearing preservation surgery has been performed in patients with acoustic neurinoma; however, the hearing preservation rate in acoustic neurinoma surgery is less than 50% of all cases [3,5,8] . For patients with unilateral acoustic neurinoma, contralateral hearing is extremely important.…”

Section: Discussionmentioning

confidence: 99%

Electrocochleographic and Pure-Tone Audiometric Findings in Contralateral Ear of Unilateral Acoustic Neurinoma

Kakigi

Nakatani²,

Takeda³

2009

ORL

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Objective: Auditory disorders of the contralateral ear in patients with unilateral acoustic neurinoma have previously been reported using the auditory brainstem response. From our survey of the literature, there is no reported result about electrocochleography (ECoG) in the contralateral ear of acoustic neurinoma cases. In the present study, we reported ECoG and pure-tone audiometric results of the contralateral ears in cases of unilateral acoustic neurinoma and the relationship between ECoG findings and tumor size was discussed. Methods: ECoG and pure-tone audiometry were performed for the contralateral ears in 27 cases of unilateral acoustic neurinoma, and the relationships between tumor size and contralateral ECoG findings and between pure-tone threshold and ECoG findings were investigated. As for ECoG findings, the negative summating potential to the compound action potential ratio (–SP/AP ratio) was examined. The tumor size was assessed by magnetic resonance imaging. Results: Abnormal –SP/AP ratio exceeding 0.40 of the upper limit of the normal range was found in 7 (25.9%) of 27 ears. Incidences of abnormal –SP/AP ratio were 30.0% in large tumors (n = 10), 33.3% in mid-size tumors (n = 6) and 18.2% in small tumors (n = 11). There was no correlation between the incidences of abnormal –SP/AP ratio and tumor size. Moreover, there was no correlation between the –SP/AP ratio and pure-tone threshold at the ECoG recording. Conclusion: These results suggest that any size of acoustic neurinoma may affect contralateral electrocochleographic findings. One possible cause may be dysfunction of the olivocochlear efferent system and another may be endolymphatic hydrops (e.g. delayed endolymphatic hydrops). Currently, however, the causes of –SP/AP ratio increase are still unknown and further investigations are required.

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Preservation of Hearing in Large Acoustic Neurinomas Following Removal via Suboccipito-Lateral Approach

Cited by 43 publications

References 23 publications

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

Surgery for vestibular schwannomas: a systematic review of complications by approach

Electrocochleographic and Pure-Tone Audiometric Findings in Contralateral Ear of Unilateral Acoustic Neurinoma

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