Retrosigmoid Approach for Small and Medium-sized Acoustic Neuromas

Magnan, Jacques; Barbieri, Marco; Mora, Renato; Murphy, Sreerama; Meller, Renaud; Bruzzo, M.; Chays, A.

doi:10.1097/00129492-200203000-00006

Cited by 88 publications

(64 citation statements)

References 24 publications

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“…In some instances, hearing is even improved after AN resection when the auditory nerve could be preserved [20]. In our patient, the surgical approach was highly beneficial to decompress the brain stem and to preserve the facial and auditory nerves as similarly reported recently [21]. The residual hearing is usually limited by the size of the schwannomas; thus, the compromised blood supply and their high invasiveness in contrast to the 'common' ANs of the cerebellopontine angle or to NF-1 patients [22][23][24][25].…”

Section: Discussionsupporting

confidence: 74%

Cochlear Implantation after Acoustic Tumour Resection in Neurofibromatosis Type 2: Impact of Intra- and Postoperative Neural Response Telemetry Monitoring

Nölle¹,

Todt²,

Basta³

et al. 2003

ORL

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The present paper reports about a 16-year-old male with neurofibromatosis type 2 (NF-2) of the Wishart type with bilateral deafness who had undergone cochlear implantation after resection of the acoustic neuroma (AN) of the same side. Neural response telemetry (NRT) recordings are essential in those patients during cochlear implantation where no stapedial reflexes can be electrically elicited due to the resection of the AN. In the present case, amplitude growth function and a type II pattern of the NRT waveforms could be well established. The comparison of the N₁ response intra-operatively and after 2 years showed a decline in latency by 50% and an increase in absolute amplitude by 10 times at the same current level of electrical stimulation. This improved auditory nerve transduction suggested a change to a ‘faster’ encoding strategy to improve speech understanding. The change from SPEAK to ACE 18 months after the operation led to an increase in the open-set sentence recognition test from 52 to 88%. Thus, NRT recordings monitor the intra-operative success of electrode placement and help to assess the integrity of the auditory pathway. Moreover, they can reliably be used in programming the speech processor postoperatively as objective tool. In patients with NF-2, the restoration of hearing can be successfully achieved in several ways. The indications for hearing implants (auditory brain stem and cochlear implants) should be carefully considered with respect to the remaining, functional integrity of the auditory nerve and the technical possibilities to monitor the success of these procedures.

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Section: Discussionsupporting

confidence: 74%

Cochlear Implantation after Acoustic Tumour Resection in Neurofibromatosis Type 2: Impact of Intra- and Postoperative Neural Response Telemetry Monitoring

Nölle¹,

Todt²,

Basta³

et al. 2003

ORL

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“…It was suggested that adjunctive use of endoscopes increases the hearing preservation rate both in retrosigmoid and middle fossa approaches [8,9] . The hearing preservation rate was 24.4% in our series.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Results of Endoscope-Assisted Acoustic Neuroma Surgery through Posterior Fossa Approach

Göksu

Yılmaz

Bayramoğlu

et al. 2005

ORL

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The objective of this study was to evaluate the results of endoscope-assisted acoustic neuroma surgery in posterior fossa approach. Between 1996 and 2002, 60 consecutive patients with acoustic neuroma were operated via the retrosigmoid suboccipital approach. Standard 4-mm sinus endoscopes at different angles were used during the surgeries either for inspection or tumor endoscopic dissection. Clinical parameters and treatment outcome were evaluated retrospectively. Tumor sizes were small, medium and large in 46.6, 45 and 8.3% of the patients, respectively. The hearing preservation rate, which did not correlate with tumor size (p > 0.05), was 24.4%. The need for facial reanimation surgery, which was needed in 5% of patients, was significantly higher in the large tumors than in the small and medium tumors (p < 0.001). Cerebrospinal fluid fistula rate, which was not related to tumor size (p > 0.05), was 13.3%. Tumor recurrence or residual tumor was not encountered at all. In conclusion, endoscopes give accurate information about the relationship between the tumor and the adjacent structures and help control the fundus of the internal auditory canal to ensure complete tumor removal. It is also helpful in visually verifying the continuity of the facial and cochlear nerves. The use of endoscopes does not appear to increase the hearing preservation rate, but is very helpful in complete tumor removal in the posterior fossa approach.

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“…For ECOG, electrodes are typically positioned transtympanically on the middle ear promontory of the pathological ear. 45,53,65,80,95,96,101,123 Reference and ground electrodes are placed on the ipsilateral earlobe and on the forehead, respectively. 64,113,114,149 A foam ear plug not only holds the electrode firmly in place but also impedes foreign substances from breaching into the ear canal.…”

Section: Electrocochleography and Direct Cnapsmentioning

confidence: 99%

“…[3][4][5][6]15,23,25,45,49,56,58,61,65,67,112,115,117,118,124,130,131 However, IONM may demonstrate improvements in structural and functional preservation of the cranial nerves during these operations. 139,148 Several IONM techniques have been developed and evaluated with particular focus on CN VII and VIII preservation.…”

mentioning

confidence: 99%

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas

Oh¹,

Nagasawa²,

Fong³

et al. 2012

FOC

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Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection.

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Retrosigmoid Approach for Small and Medium-sized Acoustic Neuromas

Abstract: The retrosigmoid approach is a safe and reliable approach in random patients with small and medium-sized acoustic neuromas.

Cited by 88 publications

References 24 publications

Cochlear Implantation after Acoustic Tumour Resection in Neurofibromatosis Type 2: Impact of Intra- and Postoperative Neural Response Telemetry Monitoring

Cochlear Implantation after Acoustic Tumour Resection in Neurofibromatosis Type 2: Impact of Intra- and Postoperative Neural Response Telemetry Monitoring

Evaluation of the Results of Endoscope-Assisted Acoustic Neuroma Surgery through Posterior Fossa Approach

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas

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