Transtemporal planned partial resection of bilateral acoustic neurinomas

Abstract

In an attempt to overcome the complete auditory deprivation of young patients with bilateral acoustic nerve schwannomas (Morbus v. Recklinghausen) a planned partial resection of the tumour was carried out in 11 hearing ears. The cerebello-pontine angle was exposed by the enlarged middle fossa approach (Wigand et al., HNO 1985). A strip of tumour was left in contiguity to the facial and cochlear nerves. Hearing was initially preserved in all cases. Four of them, however, developed total deafness after 3-39 months. Recurrent tumour growth was checked by CT scans. During the observation time one resting tumour became invisible, five remained unchanged. Two grew larger. Three cases dropped out of the follow-up. With regard to the high value of preserved auditory function during the first decades of life the planned partial resection may be considered preferable for cases of bilateral acoustic neuromas.

Hearing preservation in solitary vestibular schwannoma surgery using the retrosigmoid approach

“…This finding may reflect the complex interactions of factors involved in auditory pathway function, which are disrupted by the presence of vestibular-cochlear nerve schwannoma and surgery. However, because hearing thresholds rarely improve after surgery and there is a decline in thresholds after successful hearing-preservation surgery, 33,34 maintained preoperative hearing levels are more likely to be associated with socially preserved hearing.…”

“…Audition is a complicated process, and this simple parameter of IAD does not take into consideration the contribution residual hearing makes to sound localization 37 and to speech discrimination in noise, 38 problems patients commonly report after severe unilateral hearing loss. Further issues such as the long-term preservation of initially successful hearing 33,34 and the slight risk of residual tumor (2%) when compared with translabyrinthine approaches to tumor removal need to be taken into account when hearing-preservation surgery is planned.…”