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Hochet B, Daoudi H, Lefevre E, Nguyen Y, Bernat I, Sterkers O, Lahlou G, Kalamarides M. Monitoring Cochlear Nerve Action Potential for Hearing Preservation in Medium/Large Vestibular Schwannoma Surgery: Tips and Pitfalls. J Clin Med 2023; 12:6906. [PMID: 37959371 PMCID: PMC10650419 DOI: 10.3390/jcm12216906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The diagnosis of large vestibular schwannomas (VS) with retained useful hearing has become increasingly common. Preservation of facial nerve (FN) function has improved using intraoperative EMG monitoring, hearing preservation remains challenging, with the recent use of cochlear nerve action potential (CNAP) monitoring. This prospective longitudinal series of VS with useful hearing operated on using a retrosigmoid approach included 37 patients with a mean largest extrameatal VS. diameter of 25 ± 8.7 mm (81% of Koos stage 4). CNAP was detected in 51% of patients, while auditory brainstem responses (ABR) were present in 22%. Patients were divided into two groups based on the initial intraoperative CNAP status, whether it was present or absent. FN function was preserved (grade I-II) in 95% of cases at 6 months. Serviceable hearing (class A + B) was preserved in 16% of the cases, while 27% retained hearing with intelligibility (class A-C). Hearing with intelligibility (class A-C) was preserved in 42% of cases when CNAP could be monitored in the early stages of VS resection versus 11% when it was initially absent. Changes in both the approach to the cochlear nerve and VS resection are mandatory in preserving CNAP and improve the rate of hearing preservation.
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Affiliation(s)
- Baptiste Hochet
- Département d’Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France (O.S.); (G.L.)
| | - Hannah Daoudi
- Département d’Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France (O.S.); (G.L.)
- Technologies and Gene Therapy for Deafness, Institut de l’Audition/Institut Pasteur, 75012 Paris, France
| | - Etienne Lefevre
- Département de Neurochirurgie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France; (E.L.)
| | - Yann Nguyen
- Département d’Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France (O.S.); (G.L.)
- Technologies and Gene Therapy for Deafness, Institut de l’Audition/Institut Pasteur, 75012 Paris, France
| | - Isabelle Bernat
- Département de Neurophysiologie, Groupe Hospitalier Pitié-Salpétrière, APHP, Sorbonne Université, 75013 Paris, France
| | - Olivier Sterkers
- Département d’Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France (O.S.); (G.L.)
- Technologies and Gene Therapy for Deafness, Institut de l’Audition/Institut Pasteur, 75012 Paris, France
| | - Ghizlene Lahlou
- Département d’Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France (O.S.); (G.L.)
- Technologies and Gene Therapy for Deafness, Institut de l’Audition/Institut Pasteur, 75012 Paris, France
| | - Michel Kalamarides
- Département de Neurochirurgie, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, 75013 Paris, France; (E.L.)
- CRICM INSERM U1127 CNRS UMR 7225, Paris Brain Institute, Genetics and Development of Brain Tumors, 75013 Paris, France
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Matthies C, Zeller L, Kurz A, Rak K, Hagen R, Shehata-Dieler W. Electrically evoked auditory responses: A classification for brainstem implant placement in Neurofibromatosis Type 2. Clin Neurophysiol 2023; 155:16-28. [PMID: 37659342 DOI: 10.1016/j.clinph.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE In auditory brainstem implant (ABI) surgery, array placement may be optimized by electrophysiological information of adequate brainstem activation gained from electrically evoked auditory brainstem responses (EABR). This study aims 1) to characterize in detail the EABR from ABI implantation, 2) to introduce an EABR Classification Scheme, and 3) to analyze data for their correlation with individual patients' findings. METHODS Out of a continuous series of 54 patients who received an ABI between 2005 and 2019, 23 Neurofibromatosis Type 2 patients with complete documentation of 154 recordings were selected for offline analysis and for development and evaluation of a new EABR Classification Scheme comprising Class A: three vertex positive peaks, Class B:two peaks, Class C: a combination of one peak and a second melted double peak, Class D: one sole vertex positive peak and Class E: no peaks. RESULTS All 23 subjects showed EABR at final ABI position and experienced auditory sensations at first activation. The most frequent morphology consisted of two peaks, Classes B and C. Identified mean latencies were for P1 0.42 ms (±0.095), P2 1.42 ms (±0.244) and P3 2.41 ms (±0.329). Peak latencies correlated positively with tumor extensions (p < 0.005). CONCLUSIONS This study provides clear instructions on optimal EABR performance and evaluation. SIGNIFICANCE The new EABR Classification Scheme relies on a fast "online" identification of vertex positive peaks at the estimated post-artifact phase. The variability in EABR morphology provides an individual snapshot of the actual structural and functional status of the brainstem.
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Affiliation(s)
- Cordula Matthies
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany.
| | - Laura Zeller
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Anja Kurz
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Würzburg University Hospital, Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Würzburg University Hospital, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Würzburg University Hospital, Würzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Würzburg University Hospital, Würzburg, Germany
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Intra-Operative Cochlear Nerve Function Monitoring in Hearing Preservation Surgery: A Systematic Review of the Literature. Audiol Res 2022; 12:696-708. [PMID: 36546907 PMCID: PMC9774630 DOI: 10.3390/audiolres12060066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
With the recent scientific and technical developments, hearing preservation surgery is becoming a growing objective in inner ear pathologies, especially for vestibular schwannomas. In this review, we aim to describe the pros and cons of the following cochlear nerve monitoring techniques: ABRs (auditory brainstem responses), DENM (direct eighth cranial nerve monitoring), EcochG (electrocochleography), CNAP (cochlear compound nerve action potentials), DPOAE (distortion product otoacoustic emissions), PAMRs (postauricular muscle responses). The Cochrane library, Scopus, DynaMed, and PubMed databases were screened to obtain any relevant papers from October 2009 to the present day. Due to the heterogeneity of the existing studies in the literature, there is no way to tell whether a technique is better than another. All authors reported satisfactory outcomes with the cochlear nerve monitoring techniques tested, either alone or in combination.
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Gu F, Yang X, Wang Z, Tan X, Xue T, Chen Z, Wang Z, Chen G. Diagnostic accuracy of intraoperative brainstem auditory evoked potential for predicting hearing loss after vestibular schwannoma surgery. Front Neurol 2022; 13:1018324. [PMID: 36588877 PMCID: PMC9797509 DOI: 10.3389/fneur.2022.1018324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This meta-analysis evaluated the diagnostic value of intraoperative brainstem auditory evoked potential (BAEP) for predicting post-operative hearing loss. Methods Research articles in MEDLINE, Embase, and Cochrane Library databases were searched and selected up to 20 January 2022, and data were extracted following a standard procedure. A diagnostic accuracy test meta-analysis was performed using a mixed-effect binary regression model. Results A total of 693 patients from 15 studies were extracted. The change in intraoperative BAEP showed high sensitivity (0.95) but low specificity (0.37), with an area under the curve of 0.83. Diagnostic accuracy of the loss of potentials showed high sensitivity (0.82) and specificity (0.79). The area under the curve was 0.88. No factor was found to account for the heterogeneity of the results according to the meta-regression and subgroup analyses (all P-values > 0.05). Conclusions Our results showed that the loss of BAEP has meaningful value for predicting hearing loss after vestibular schwannoma surgery. The change in BAEP is also important for its high sensitivity during hearing preservation surgery.
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Affiliation(s)
- Feng Gu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Tan
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Zhouqing Chen
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,*Correspondence: Zhong Wang
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: Predicting Cutoffs. Otol Neurotol 2021; 41:686-693. [PMID: 32118808 DOI: 10.1097/mao.0000000000002602] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the outcomes of hearing preservation surgery (HPS) for acoustic neuroma and quantify tumor and patient characteristics predictive of hearing preservation after surgery. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS A total of 100 consecutive patients diagnosed with acoustic neuroma from 2000 to 2012. INTERVENTION Hearing preservation surgery through microscopic retrosigmoid approach combined with a retrolabyrinthine meatotomy. MAIN OUTCOME MEASURE Pre- and postoperative hearing stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Tokyo classifications. The most accurate cutoff was identified for each tumor and patients' variable affecting the outcome by calculating the Youden index. A multivariable analysis was undertaken at these cutoffs to identify prognostic factors for hearing preservation. RESULTS Preoperative hearing class was preserved after surgery in 31% (AAO-HNS), and 39% (Tokyo classification) of patients. According to the AAO-HNS classification, the tumor size in the cerebello-pontine angle, pure-tone average (PTA), and speech discrimination score cutoffs for predicting good postoperative hearing function were 7 mm, 21 dB, and 90%, respectively. With the Tokyo classification, only the PTA cutoff differed, with 27 dB. On multivariable analysis, tumor size and PTA were independent prognostic factors for postoperative hearing with high model's goodness of fit (area under the curve = 0.784; 95% CI = 0.68-0.88 and area under the curve = 0.813; 95% CI = 0.72-0.90), according to both the hearing classifications. CONCLUSIONS The estimated cutoffs for tumor size and PTA were independently associated with HPS. These factors should be prospectively investigated before they are adopted as selection criteria for HPS.
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Risk Stratification for Immediate Postoperative Hearing Loss by Preoperative BAER (Brainstem Auditory Evoked Response) and Audiometry in NF2-Associated Vestibular Schwannomas. Cancers (Basel) 2021; 13:cancers13061384. [PMID: 33803788 PMCID: PMC8003145 DOI: 10.3390/cancers13061384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Hearing preservation is one of the major goals in the surgical treatment of Neurofibromatosis Type 2 (NF2) associated vestibular schwannomas (VS) and hearing diagnostics are important monitoring parameters and intraoperative tools to pursue this goal. Our monocentric retrospective analysis aimed to predict postoperative hearing deterioration or loss based on preoperative audiometry and neurophysiological (brainstem auditory evoked potentials, BAEP) findings. In this respect and according to our data evaluation in 100 NF2-associated VS of 72 patients both parameters seem to be prognostic markers, particularly BAEP findings. Large discrepancies between both audiometry and BAEPs which were identified in twenty-one cases of our cohort appear to be at high risk of significant postoperative hearing worsening. Abstract Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology–Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73% of ears and approximately ~60% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48–100%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring.
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Huang B, Yan L, Zhang Z, Yang X, Xiao Z. General anesthetic induced differential changes in latency of auditory evoked potential in the central nucleus of inferior colliculus of mouse. Neurosci Lett 2019; 708:134325. [DOI: 10.1016/j.neulet.2019.134325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Zakaria MN, Jalaei B. Test-retest reliability of speech-evoked auditory brainstem response in healthy children at a low sensation level. Int J Pediatr Otorhinolaryngol 2017; 102:28-31. [PMID: 29106871 DOI: 10.1016/j.ijporl.2017.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Auditory brainstem responses evoked by complex stimuli such as speech syllables have been studied in normal subjects and subjects with compromised auditory functions. The stability of speech-evoked auditory brainstem response (speech-ABR) when tested over time has been reported but the literature is limited. The present study was carried out to determine the test-retest reliability of speech-ABR in healthy children at a low sensation level. METHODS Seventeen healthy children (6 boys, 11 girls) aged from 5 to 9 years (mean = 6.8 ± 3.3 years) were tested in two sessions separated by a 3-month period. The stimulus used was a 40-ms syllable /da/ presented at 30 dB sensation level. RESULTS As revealed by pair t-test and intra-class correlation (ICC) analyses, peak latencies, peak amplitudes and composite onset measures of speech-ABR were found to be highly replicable. Compared to other parameters, higher ICC values were noted for peak latencies of speech-ABR. CONCLUSION The present study was the first to report the test-retest reliability of speech-ABR recorded at low stimulation levels in healthy children. Due to its good stability, it can be used as an objective indicator for assessing the effectiveness of auditory rehabilitation in hearing-impaired children in future studies.
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Affiliation(s)
- Mohd Normani Zakaria
- Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Bahram Jalaei
- Department of Audiology, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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