Simultaneous cochlear implantation as a therapeutic option in vestibular schwannoma surgery: case report

Neto, Pedro H. dos Santos; Zamponi, Johnni Oswaldo; Hamerschmidt, Rogério; Wiemes, Gislaine Richter Minhoto; Rassi, Marcio S.; Borba, Luis A. B.

doi:10.3171/2017.12.focus17670

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Cochlear implantation is a relatively new indication for hearing restoration in some VS patients and is relevant when the cochlear nerve is preserved during microsurgical tumor resection, following stereotactic radiation surgery, or when tumor resection is not attempted due to the tumor’s small size and the patient’s overall medical condition [ 84 ]. A retrospective cohort study of VS patients with tinnitus reported that median Tinnitus Handicap Inventory scores significantly improved after CI implantation (n = 17) [ 80 ], which is consistent with several prior small cohort studies that also reported improvements in tinnitus symptoms with CIs [ 85 , 86 , 87 ]. However, VS tumor management and the tumors themselves may have unpredictable effects on CIs’ function given the damage to the vestibulocochlear nerve.…”

Section: Discussionsupporting

confidence: 85%

Comparative Transcriptomic Analysis of Archival Human Vestibular Schwannoma Tissue from Patients with and without Tinnitus

Bommakanti

Seist

Kukutla

et al. 2023

JCM

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Vestibular schwannoma (VS) is an intracranial tumor that commonly presents with tinnitus and hearing loss. To uncover the molecular mechanisms underlying VS-associated tinnitus, we applied next-generation sequencing (Illumina HiSeq) to formalin-fixed paraffin-embedded archival VS samples from nine patients with tinnitus (VS-Tin) and seven patients without tinnitus (VS-NoTin). Bioinformatic analysis was used to detect differentially expressed genes (DEG; i.e., ≥two-fold change [FC]) while correcting for multiple comparisons. Using RNA-seq analysis, VS-Tin had significantly lower expression of GFAP (logFC = −3.04), APLNR (logFC = −2.95), PREX2 (logFC = −1.44), and PLVAP (logFC = −1.04; all p < 0.01) vs. VS-NoTin. These trends were validated by using real-time RT-qPCR. At the protein level, immunohistochemistry revealed a trend for less PREX2 and apelin expression and greater expression of NLRP3 inflammasome and CD68-positive macrophages in VS-Tin than in VS-NoTin, suggesting the activation of inflammatory processes in VS-Tin. Functional enrichment analysis revealed that the top three protein categories—glycoproteins, signal peptides, and secreted proteins—were significantly enriched in VS-Tin in comparison with VS-NoTin. In a gene set enrichment analysis, the top pathway was allograft rejection, an inflammatory pathway that includes the MMP9, CXCL9, IL16, PF4, ITK, and ACVR2A genes. Future studies are needed to examine the importance of these candidates and of inflammation in VS-associated tinnitus.

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Section: Discussionsupporting

confidence: 85%

Comparative Transcriptomic Analysis of Archival Human Vestibular Schwannoma Tissue from Patients with and without Tinnitus

Bommakanti

Seist

Kukutla

et al. 2023

JCM

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“…13,14 There were 5 of the 21 subjects who either did not have open-set recognition tested or were not reported. [18][19][20][21] One of these subjects had subjective recognition, but formal testing was deferred due to the patient only speaking Spanish. 19 A subject detailed by dos Santos Neto et al showed improvement in both Ling Sound Test and identification of vocabulary extension compared to baseline measures.…”

Section: Speech Perception Outcomesmentioning

confidence: 99%

“…19 A subject detailed by dos Santos Neto et al showed improvement in both Ling Sound Test and identification of vocabulary extension compared to baseline measures. 21…”

Section: Speech Perception Outcomesmentioning

confidence: 99%

Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation: Systematic Review

2019

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Objectives Hearing rehabilitation is an important management aspect of patients undergoing excision of vestibular schwannomas. Studies have shown cochlear implantation (CI) is possible at the time of tumor excision via a translabyrinthine approach. Primary objectives of this report are (1) to review prospective studies pertaining to outcomes of concurrent CI and translabyrinthine tumor removal in detail and (2) perform an aggregate analysis of outcomes for case reports and series. Design Systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Setting Review of literature using PubMed and Cochrane databases. Participants Eligibility included patients undergoing translabyrinthine excision of vestibular schwannoma with concurrent CI. Main Outcome Measures Open-set speech discrimination scores, sound localization, patient-reported outcome measures. Results Forty-one subjects were identified. Two prospective studies have been performed, which showed improvement in speech localization and patient-reported outcome measures. While the majority of patients achieved open set speech recognition, data pertaining to improvement in speech perception were variable. Approximately 85% of subjects had audibility with their CI. Of those that achieved open-set speech discrimination, 75% could be classified as either intermediate or high performers. The majority of low performers in open-set speech either endorsed subjective benefit or demonstrated improvement compared to preoperative measures. There was a high risk of selection and reporting bias. Conclusions The majority of patients undergoing translabyrinthine excision of vestibular schwannoma with concurrent CI achieve open set speech perception, with 75% of these patients meeting criteria for being intermediate to high performers. Additional benefits include improved subjective hearing measures, decreased tinnitus, and improved sound localization.

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“…For the patients with TFIAC grade III or TFIAC grade IV, cochlear implantation may provide a favorable hearing restoration, which will apparently reopen discussions about AN management. Some studies have suggested surgical tumor removal combined with cochlear implantation is a promising treatment strategy in the management of AN patients with unilateral hearing loss and severe tinnitus [42,43]. In our study, we found that TFIAC grade III or IV AN patients had lower rates of hearing preservation after surgical treatment, suggesting that these patients had limited hearing preservation benefits from tumor removal.…”

Section: Tfiac Classification Determines the Optimal Timing Of Interventionmentioning

confidence: 44%

A Novel Imaging Grading Biomarker for Predicting Hearing Loss in Acoustic Neuromas

Zhou

Wang

et al. 2020

Clin Neuroradiol

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The aim of this study was to investigate an imaging biomarker based on contrast enhanced T1-weighted and T2-weighted magnetic resonance imaging (MRI) to determine the hearing loss related to acoustic neuromas (AN). Methods In this retrospective study, 441 acoustic neuromas treated with microsurgery were included. The diagnostic and follow-up MRI and audiometry of these patients were compared. Results We discovered a new MRI grading biomarker based on the percentage of tumor filling the inner auditory canal (TFIAC classification). The area under the receiver operating characteristics (AUROC) curve was highest for TFIAC (0.675), followed by period of observation (0.615) and tumor size (0.6) (P < 0.001). The percentage of patients in TFIAC grade III (90.1%) experiencing hypoacusis prior to microsurgery was significantly higher than that in TFIAC grade I (72.7%, P = 0.037) and TFIAC grade IV patients had a higher rate of non-serviceable hearing compared to TFIAC grade III patients (P < 0.001). During the follow-up, TFIAC grade IV patients experienced a significantly higher rate of non-serviceable hearing than TFIAC grade III patients in all ANs (P < 0.001) and in serviceable hearing acoustic neuroma cases prior to surgery (TFIAC grade IV 55.4%, TFIAC grade III 69.0%, P = 0.045). The TFIAC grade IV patients experienced a significantly higher rate of facial nerve dysfunction than TFIAC grade III patients after surgery (grade IV 48.0%, grade III 26.1%, P < 0.001). ConclusionThe TFIAC classification serves as a potential imaging biomarker for preoperative and postoperative hearing prediction in ANs, which may aid neurosurgeons in predicting hearing loss and selecting optimal surgical strategies.

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Simultaneous cochlear implantation as a therapeutic option in vestibular schwannoma surgery: case report

Cited by 12 publications

References 27 publications

Comparative Transcriptomic Analysis of Archival Human Vestibular Schwannoma Tissue from Patients with and without Tinnitus

Comparative Transcriptomic Analysis of Archival Human Vestibular Schwannoma Tissue from Patients with and without Tinnitus

Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation: Systematic Review

A Novel Imaging Grading Biomarker for Predicting Hearing Loss in Acoustic Neuromas

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