The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

Abstract

S enSorineural hearing loss after microvascular decompression (MVD) has a reported incidence of 1%-23.8% when performed for trigeminal neuralgia (TGN), 1.5%-4.2% for glossopharyngeal neuralgia (GPN), and 22% for geniculate neuralgia (GN). 21,24,25,27 Because of the proximity of the cranial nerve VIII to cranial nerves decompressed during the procedure, the auditory nerve in many patients is often stretched or damaged, resulting in hearing impairment. Although sensorineural hearing loss after MVD is frequently documented and well understood, high-frequency hearing loss (HFHL) is currently not well recognized. HFHL has been recently reported after MVD for hemifacial spasm (HFS). . disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN). methods The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz. results The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss. coNclusioNs High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.

Nervus intermedius and the surgical management of geniculate neuralgia

“…Should both techniques fail, we recommend exposure of the internal acoustic canal and retrograde tracing of the NI; however, this should be reserved as a last resort, given the potential for increased risk of facial nerve injury, deafness, vestibulopathy, and CSF leak due to temporal bone drilling. 1,7,13,15,16 The results of our study are subject to several significant limitations, including small cohort sizes in both the primary and repeat surgery groups, short median follow-up of 11 months, and the inherent risks of bias and confounding that are associated with any retrospective analysis. With respect to the systematic review, the included studies were scattered over a broad range of years and techniques, outcomes were reported inconsistently and heterogeneously, and the small sample sizes and inconsistent data prohibited formal statistical analysis.…”

Microvascular decompression for glossopharyngeal neuralgia using intraoperative neurophysiological monitoring: Technical case report

“…[ 2 ] As IONMs, BAEP and facial MEP plays important roles in avoiding hearing loss and facial paresis after MVD, not only for hemifacial spasm (HFS), but also for GN. [ 29 ]…”

Suprafloccular approach via the petrosal fissure and venous corridors for microvascular decompression of the trigeminal nerve: technique notes and clinical outcomes

“…Surgical corridors used in each operation were determined by both the operative notes and videos made during intraoperative microscopic recording. We eventually used the lateral corridor in 219 (52.1%) cases, the medial corridor in 175 (41.7%) cases, and the intermediate corridor in 26 ing of the vein anchor point occurred in 4 cases via the lateral corridor after gelatin compression hemostasis was achieved, and the surgical approach was changed immediately to the medial or intermediate corridor.…”

“…vein itself must be cut off, which undoubtedly increases the possibility of vein injury, 5,18 cerebellar edema or hematoma, 8,17 hearing impairment, 26 facial paralysis, 2 or a life-threatening event. 1 Fujimaki and Kirino 9 and Zhu and coworkers 28 described the transhorizontal, or cerebellar-fissure, approach in MVD surgery for decreasing the risk of petrosal vein and seventh cranial nerve injury.…”