Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling

Mohr, Gérard; Sade, Burak; Dufour, Jean-Jacques; Rappaport, Jamie M.

doi:10.3171/jns.2005.102.1.0001

Cited by 132 publications

(46 citation statements)

References 32 publications

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“…However, large tumors (>3 cm) pose treatment difficulties with reported cranial nerve preservation rates well below the rates seen for small or medium tumors 1,[5][6][7][8] . .…”

Section: Discussionmentioning

confidence: 99%

“…It is well documented that there can be normal hearing with large tumors and deafness with very small intrameatal lesions 6 . Elevation of pressure in the internal auditory canal has been demonstrated to occur in tumors with intracanalicular extension, and pressure on the cochlear nerve and on the vascular structures can make the nerve vulnerable during drilling and dissection 8 . Most often, despite anatomic cochlear nerve preservation, there is no function postoperatively Accepted prognostic factors for hearing preservation seem to be tumor size and extension, pre-operative hearing and the degree of involvement of the IAC 1,3,8 .…”

Section: Facial Nerve Function -mentioning

confidence: 99%

“…Elevation of pressure in the internal auditory canal has been demonstrated to occur in tumors with intracanalicular extension, and pressure on the cochlear nerve and on the vascular structures can make the nerve vulnerable during drilling and dissection 8 . Most often, despite anatomic cochlear nerve preservation, there is no function postoperatively Accepted prognostic factors for hearing preservation seem to be tumor size and extension, pre-operative hearing and the degree of involvement of the IAC 1,3,8 . If the tumor extends deeply to the fundus, it is difficult to expose the lesion without entering the labyrinth, and the extent of labyrinth opening influences hearing preservation 11 .…”

Section: Facial Nerve Function -mentioning

confidence: 99%

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Normal hearing after resection of a large vestibular schwannoma

Braga

Cabral-Filho

Vilela

2008

Arq. Neuro-Psiquiatr.

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Advances in anesthesia and surgical techniques have brought the surgical mortality rate for vestibular schwannomas (VS) to less than 1% [1][2][3] . Increased preservation rates of facial and cochlear function were observed in the most recent large series by Samii et al.1 . Nevertheless, preservation of House-Brackmann grade I and Hannover Class H1 (PTA <20dB and SDS >95%) hearing function postoperatively after total removal of large tumors is still a challenge, even in experienced hands 1,2,[4][5][6] . Our objective is to add to the literature a case of a large VS that was totally excised, with preservation of normal facial and hearing functions. Details on the surgical technique are presented. CASE Case descriptionA 30-year-old female presented with a 2-month history of trigeminal neuralgia in the right V3 distribution, along with normal hearing, an unusual symptomatology for a large VS. Neurological examination was normal. Imaging studies showed a large (34 × 33 × 28 mm), enhancing, spherical mass in the right cerebellopontine angle with erosion of the porus acusticus but no dural tail. A vestibular schwannoma, extension Class T4b (IV ventricle was compressed and distorted), was diagnosed (Fig 1). Her audiometry showed Class H1 hearing in the right ear. Surgical techniqueA three-quarter prone position was used, with the nose pointing up 10 degrees and vertex tilted 15 degrees down, relative to the operating room floor. A lumbar drain was used to drain 50 cc mL CSF throughout the opening. A standard suboccipital retrosigmoid approach was used and the cerebellum was gently retracted after opening the Cisterna Magna. The bed was totally rotated away so the surgeon could have a tangential view of the internal auditory canal (IAC). The configuration of the lesion allowed drilling the posterior lip of the porus, which was followed by internal debulking of the tumor using microinstruments. The intrameatal portion of the facial nerve was then identified at the fundus with the aid of a monopolar stimulator. We used facial nerve monitoring throughout but no cochlear nerve monitoring was done. Although we did not expect preservation of hearing, all attempts were made to preserve the cochlear nerve intact. The cochlear and facial nerves were preserved anatomically with a glistening layer of arachnoid overlying their posterior surface, to avoid any stretching on them. Facial nerve function was confirmed at the end of the case by stimulation at the brainstem using a 0.1 mA current. Total removal was confirmed after inspection of the tumor bed. Hemostasis was carefully done. The meatus was covered with a free muscle graft and biological glue. A cranioplasty was performed using polymethylmethacrylate after a watertight dural

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“…However, large tumors (>3 cm) pose treatment difficulties with reported cranial nerve preservation rates well below the rates seen for small or medium tumors 1,[5][6][7][8] . .…”

Section: Discussionmentioning

confidence: 99%

Section: Facial Nerve Function -mentioning

confidence: 99%

Section: Facial Nerve Function -mentioning

confidence: 99%

See 1 more Smart Citation

Normal hearing after resection of a large vestibular schwannoma

Braga

Cabral-Filho

Vilela

2008

Arq. Neuro-Psiquiatr.

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“…3A and B), low degree of meatal filling (Fig. 3A), tumor origin in the superior vestibular nerve, 8,14 mild adhesion at the cochlear nerve-tumor interface ( Fig. 3C and D), 28 oligodendroglial myelin coverage at the cisternal segment of the cochlear nerve, 20 maintenance of cochlear nerve microcirculation, 25 and shorter absolute wave-V latency.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative monitoring of the facial nerve 7,26,27,30 and the cochlear nerve is essential for improved preservation of function after surgery, but conventional monitoring methods have proven inadequate. 8,14,15,20,28 Therefore, novel methods (continuous direct neurophysiological monitoring) have been introduced to achieve immediate intraoperative feedback and successful prognostic assessment. 2,6,[10][11][12]16,17,21,25 Two methods that have the potential to Improved preservation of function during acoustic neuroma surgery warn neurosurgeons of neural damage directly caused by surgical procedures are continuous direct auditory evoked dorsal cochlear nucleus action potential (AEDNAP) monitoring and facial nerve root exit zone-elicited compound muscle action potential (FREMAP) monitoring.…”

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confidence: 99%

Improved preservation of function during acoustic neuroma surgery

Nakatomi

Miyazaki

Tanaka

et al. 2015

JNS

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OBJect Restoration of cranial nerve functions during acoustic neuroma (AN) surgery is crucial for good outcome. The effects of minimizing the injury period and maximizing the recuperation period were investigated in 89 patients who consecutively underwent retrosigmoid unilateral AN surgery. MetHODS Cochlear nerve and facial nerve functions were evaluated during AN surgery by use of continuous auditory evoked dorsal cochlear nucleus action potential monitoring and facial nerve root exit zone-elicited compound muscle action potential monitoring, respectively. Factors affecting preservation of function at the same (preoperative) grade were analyzed. reSUltS A total of 23 patients underwent standard treatment and investigation of the monitoring threshold for preservation of function; another 66 patients underwent extended recuperation treatment and assessment of its effect on recovery of nerve function. Both types of final action potential monitoring response and extended recuperation treatment were associated with preservation of function at the same grade. cOnclUSiOnS Preservation of function was significantly better for patients who received extended recuperation treatment.http://thejns.org/doi/abs/10.3171/2014.8.JNS132525KeY WOrDS acoustic neuroma surgery; continuous direct brainstem auditory evoked potential monitoring; oncology aBBreViatiOnS AEDNAP = auditory evoked dorsal cochlear nucleus action potential; AN = acoustic neuroma; APR = amplitude preservation ratio; AUC = area under the curve; BAEP = brainstem auditory-evoked potential; FREMAP = facial nerve root exit zone-elicited compound muscle action potential; GR = Gardner-Robertson; HB = House-Brackmann; M-max = maximum peak-to-peak amplitude; ROC = receiver operating characteristic.

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Tumor growth rate: A new prognostic indicator of hearing preservation in vestibular schwannoma surgery

et al. 2019

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Background The management of small‐ to medium‐size (< 20 mm) sporadic vestibular schwannomas (VSs) continues to inspire debate. Preoperative pure tone thresholds and tumor size are recognized prognostic features of hearing preservation after surgery. Objective To investigate what preoperative characteristics were associated with nonserviceable hearing after surgery for VSs. Methods We retrospectively reviewed the audiological results of 92 patients treated with the middle cranial fossa (MCF) approach for resection of VSs (< 20 mm). Sex, age, symptoms, tumor site, tumor size, growth rate, and hearing class according to American Academy of Otolaryngology–Head and Neck Surgery guidelines were evaluated. Negative outcome was progression after surgery to nonserviceable hearing according to Gardner‐Robertson classification. We included only patients with preoperative serviceable hearing. Results After surgery, 48 patients (52.2%) had nonserviceable hearing. At univariate analysis, sex age, symptoms, tumor site, and size were not associated to hearing outcome. Tumor growth rate ≥ 2.16 mm/year (P = 0.02, odds ratio 8.5) and preoperative hearing class B (P = 0.03, OR 5.89) were statistically associated to nonserviceable hearing after VSs resection. Tumor growth rate ≥ 2.16 mm/year was also significantly associated to preoperative hearing class B (P = 0.01). At multivariate analysis, the only independent prognostic factor of progression to nonserviceable hearing in operated VSs was tumor growth rate ≥ 2.16 mm/year (P = 0.01, OR = 4.15). Conclusion We found a new prognostic indicator of hearing preservation after VS surgery with the MCF approach: the tumor growth rate. This feature should be further investigated before being considered in the decision‐making process of VS treatment. Level of Evidence 4 Laryngoscope, 129:2378–2383, 2019

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Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling

Cited by 132 publications

References 32 publications

Normal hearing after resection of a large vestibular schwannoma

Normal hearing after resection of a large vestibular schwannoma

Improved preservation of function during acoustic neuroma surgery

Tumor growth rate: A new prognostic indicator of hearing preservation in vestibular schwannoma surgery

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