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Lassaletta L, Calvino M, Díaz M, Morales-Puebla JM, Sánchez-Cuadrado I, Varela-Nieto I, Gavilán J. Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned. Hear Res 2024; 446:108997. [PMID: 38564963 DOI: 10.1016/j.heares.2024.108997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition. Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation. Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case. The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.
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Affiliation(s)
- Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miryam Calvino
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Díaz
- MED-EL Elektromedizinische Geräte GmbH. Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Isabel Varela-Nieto
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
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Dahm V, Gadenstaetter AJ, Arnoldner C. "To implant or not to implant": electrically evoked auditory brainstem response audiometry for decision-making in vestibular schwannoma resection with CI. HNO 2024:10.1007/s00106-024-01471-6. [PMID: 38647665 DOI: 10.1007/s00106-024-01471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 04/25/2024]
Abstract
Vestibular schwannomas (VS) are often associated with debilitating hearing loss. Therefore, preservation and rehabilitation of hearing have become major therapeutic goals of VS management. Recently, cochlear implantation (CI) has been established as an effective treatment option for VS-associated hearing loss. Nevertheless, the integrity and proper function of the cochlear nerve must be evaluated before conducting CI to ensure optimal CI outcomes. Various methods to determine cochlear nerve integrity and functionality have emerged in the last few years. Of these, the use of electrically evoked auditory brainstem response audiometry (eABR) in particular has been proven to be a meaningful tool for monitoring cochlear nerve health during VS surgery. Here, the cochlear nerve can be electrically stimulated using an intracochlear test electrode before, during, and after tumor extirpation. Subsequently, the resulting brainstem responses can be measured and interpreted accordingly to obtain direct information on the cochlear nerve function. This allows for continuous monitoring of cochlear nerve function throughout the course of VS surgery and aids in the decision-making for CI candidacy. Finally, in the case of preserved brainstem responses, CI can be performed instantly after VS extirpation. This simultaneous approach offers several advantages over two-staged procedures and has been shown to be an efficient and safe procedure for restoring hearing after VS removal.
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Affiliation(s)
- Valerie Dahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anselm Joseph Gadenstaetter
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Esser J, Walger M, Pollet N, Klußmann JP, Ruge M, Goldbrunner R, Lüers JC. [Vestibular Schwannoma: Factors in Therapy Decision-Making]. Laryngorhinootologie 2024; 103:176-186. [PMID: 38128578 DOI: 10.1055/a-2222-0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and stereotactic radiotherapy. In addition to the type of treatment, decisions must be made regarding the optimal timing of therapy, the combination of different treatment modalities, the potential surgical approach, and the type and intensity of radiation. Factors influencing the therapy decision include tumor location and size or stage, patient age, comorbidities, symptoms, postoperative hearing rehabilitation options, patient preferences, and, not least, the experience of the surgeons and the personnel and technical capabilities of the clinical site. This article begins with a brief overview of vestibular schwannomas, then outlines the fundamental interdisciplinary treatment options, and finally discusses the ENT (ear, nose, and throat)-relevant factors in the therapy decision.
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Affiliation(s)
- Julia Esser
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Martin Walger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Naomi Pollet
- Universität zu Köln, Medizinische Fakultät, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Uniklinik Köln, Köln, DE 50937, Germany
| | - Jens Peter Klußmann
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Maximilian Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Roland Goldbrunner
- Universität zu Köln, Medizinische Fakultät, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Jan Christoffer Lüers
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
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