Simultaneous Cochlear Implantation After Translabyrinthine Vestibular Schwannoma Resection: A Report of 41 Cases

Abstract

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

“…At 1-year follow-up, 48.8% of patients were CI users compared with 51.2% nonusers. In the user group, the sentence recognition score was 31% at activation and 61% at 12-month follow-up, in contrast to nonusers who demonstrated sentence recognition scores of 2.9 and 15.3%, respectively (1). Furthermore, a recent systematic review looking at the outcomes of concurrent CI and translabyrinthine removal of VS found that 85% of patients achieved audibility through the CI.…”

“…Recent successes with simultaneous cochlear implantation and resection of vestibular schwannoma (VS) and evolving indications for cochlear implant (CI) use in single-sided deafness have expanded the available management options for patients with VS and nonserviceable hearing. (1,2). If simultaneous or subsequent CI is being considered for patients managed with microsurgical resection, intraoperative anatomic and functional preservation of the cochlear nerve is of utmost importance.…”

Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in “Larger” Tumors?

“…Recent data, both from the adult single-sided deafness literature and within the VS population, indicate that cochlear implantation may ameliorate many of these deficits by reinstating binaural cues. 6,7,9,10 As a requisite for cochlear implantation in the VS population, the cochlear nerve must be anatomically intact and sufficiently healthy to transmit an electrical signal, and the cochlea must be largely patent for electrode placement. Implantation in this population is particularly appealing for patients with neurofibromatosis type 2 or contralateral hearing loss from unrelated factors.…”

“…A recent study including 41 patients undergoing simultaneous TL VS resection and cochlear implantation reported that 81% of patients achieved sound perception and 49% remained long-term device users. 9 If cochlear implantation is being considered within the context of TL surgery, concomitant device placement (or at a minimum a cochlear spacer) is advisable given the high prevalence of early cochlear obliteration with this approach compared to others. 34 While the cochlear nerve can be anatomically preserved in both a TL and RS approach, the cochlea is less likely to develop early prohibitive ossification following the RS approach, effectively offering two opportunities to preserve or restore ipsilateral hearing.…”

“…Most recently, cochlear implantation has emerged as a viable rehabilitative option for select patients with VS, potentially offering restitution of ipsilateral hearing. [6][7][8][9][10] Tumor size has been identified as a primary predictor of successful hearing preservation following microsurgical resection. [11][12][13][14][15][16] Based on prior data suggesting a low likelihood of functional hearing preservation with medium-tolarge sized VS, some have recommended forgoing attempts at hearing preservation once a VS reaches a certain size threshold (e.g., 15 mm cerebellopontine angle [CPA] dimension), instead preferring a translabyrinthine (TL) approach to reduce potential morbidity.…”