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Jones A, Saputra L, Matthews T. Reduced Cochlear MRI Signal and Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients. Otol Neurotol 2024; 45:e547-e553. [PMID: 38924020 DOI: 10.1097/mao.0000000000004239] [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: 06/28/2024]
Abstract
OBJECTIVE This study aimed to determine if hypointense cochlear magnetic resonance imaging (MRI) constructive interference in steady-state (CISS) signal correlates with hearing outcomes in conservatively managed vestibular schwannoma (VS) patients. STUDY DESIGN Retrospective review of 657 cases from 1992 to 2020. SETTING Tertiary academic referral center. PATIENTS A retrospective review was performed to identify conservatively managed VS patients with appropriate baseline MRI, audiology, and at least 12-month audiological follow-up. Patients were excluded if they progressed to surgery or radiotherapy in less than 12 months, bilateral tumors, or surgery on the contralateral ear. INTERVENTION Conservatively managed patients with CISS imaging studies and audiology testing. MAIN OUTCOME MEASURES Primary outcome measure change in pure-tone average (PTA) and word recognition score (WRS). Secondary outcome measures tumor size, presence of lateral fluid cap, or cystic changes. RESULTS A total of 92 individuals (47% male, 58 ± 11.6 yr) met the inclusion criteria, with 36 (39%) of patients demonstrating abnormal cochlear CISS signal. At baseline, abnormal cochlear CISS signal was associated with higher intracanalicular (IC) length (7.9 versus 6.6 mm, p = 0.0177) and lower WRS (55.7 versus 78.8 dBHL, p = 0.0054). During follow-up, individuals with abnormal cochlear CISS signal had significantly higher PTA (62.4 versus 46.4 dBHL, p = 0.0010). After adjusting for baseline covariates, abnormal cochlear CISS signal was consistently associated with a greater increase in PTA of 8.3 dBHL (95% confidence interval, 2.9-13.7; p = 0.0032) from baseline when compared with the normal group. CONCLUSIONS Abnormal cochlear signal on MRI CISS sequences is associated with poorer hearing outcomes in conservatively managed VS patients.
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Affiliation(s)
- Arthur Jones
- Department of Otolaryngology, Head and Neck Surgery, Canberra Hospital, Garran, ACT, Australia
| | - Lydia Saputra
- Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia
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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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West NC, Groth JB, Cayé-Thomasen P. Does Location of Intralabyrinthine Vestibular Schwannoma Determine Objective and Subjective Vestibular Function? Otol Neurotol 2024; 45:319-325. [PMID: 38291789 DOI: 10.1097/mao.0000000000004115] [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: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE The incidence of intralabyrinthine schwannomas is increasing, and a growing attention is given to the detrimental effects on hearing function. On the contrary, the vestibular profile of intralabyrinthine vestibular schwannomas (VSs) is still not well understood. We aimed to investigate and report the observed relationships between the intralabyrinthine location of the schwannomas and objective and subjective vestibular profile of the patients. METHODS Retrospective cohort study of 20 consecutive individuals with sporadic intralabyrinthine schwannomas and grouped according to the intralabyrinthine location of the schwannomas. Vestibular testing consisted of the video head impulse test of all three semicircular canals, the caloric test, cervical and ocular vestibular evoked myogenic potentials, and the dizziness handicap inventory. A nonparametric unpaired t test was performed to compare groups, and Fisher's exact test was used for categorical data. RESULTS The median video head impulse test gains (lateral, anterior, posterior) were 0.40, 0.50, and 0.75 for intravestibular schwannomas and 0.93, 1.52, and 0.91 for intracochlear schwannomas ( p = 0.0001, p = 0.009, p = 0.33), respectively. Caloric unilateral weakness had a median of 100% for intravestibular schwannomas and 14% for intracochlear schwannomas ( p = 0.0001). The mean dizziness handicap inventory was 21 for intravestibular schwannomas and 1 for cochlear schwannomas ( p = 0.02). There were no significant differences in vestibular evoked myogenic potentials according to intralabyrinthine location. CONCLUSION By both objective and subjective measures, intralabyrinthine schwannomas with an intravestibular component has significantly worse vestibular function than schwannomas with purely cochlear involvement.
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Affiliation(s)
- Niels Cramer West
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen
| | - Jane Bjerg Groth
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen
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Maxwell AK, Kahane JB, Mehta R, Arriaga MA. Cochlear implantation through intracochlear fibrosis: A comparison of surgical techniques. Cochlear Implants Int 2022:1-10. [DOI: 10.1080/14670100.2022.2153968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anne K. Maxwell
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar St, Suite 566, New Orleans, LA 70112, USA
| | - Jacob B. Kahane
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar St, Suite 566, New Orleans, LA 70112, USA
| | - Rahul Mehta
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar St, Suite 566, New Orleans, LA 70112, USA
| | - Moises A. Arriaga
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar St, Suite 566, New Orleans, LA 70112, USA
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Fan Y, Banalagay RA, Cass ND, Noble JH, Tawfik KO, Labadie RF, Dawant BM. Automatic Segmentation of Intracochlear Anatomy in MR Images Using a Weighted Active Shape Model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3573-3576. [PMID: 34892011 PMCID: PMC8964074 DOI: 10.1109/embc46164.2021.9630332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is evidence that cochlear MR signal intensity may be useful in prognosticating the risk of hearing loss after middle cranial fossa (MCF) resection of acoustic neuroma (AN), but the manual segmentation of this structure is difficult and prone to error. This hampers both large-scale retrospective studies and routine clinical use of this information. To address this issue, we present a fully automatic method that permits the segmentation of the intra-cochlear anatomy in MR images, which uses a weighted active shape model we have developed and validated to segment the intra-cochlear anatomy in CT images. We take advantage of a dataset for which both CT and MR images are available to validate our method on 132 ears in 66 high-resolution T2-weighted MR images. Using the CT segmentation as ground truth, we achieve a mean Dice (DSC) value of 0.81 and 0.79 for the scala tympani (ST) and the scala vestibuli (SV), which are the two main intracochlear structures.Clinical Relevance- The proposed method is accurate and fully automated for MR image segmentation. It can be used to support large retrospective studies that explore relations between MR signal in preoperative images and outcomes. It can also facilitate the routine and clinical use of this information.
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Talas DÜ, Beger O, Vayisoğlu Y, Hamzaoğlu V, Özalp H, Çakır S, Dağtekin A, Bağdatoğlu C. Cochleo-facial corridor to the vestibule and fundus of the internal auditory canal through oval window: a minimal invasive and cochlea sparing approach. Eur Arch Otorhinolaryngol 2021; 279:627-637. [PMID: 33595698 DOI: 10.1007/s00405-021-06680-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This cadaveric work aimed to test the effectiveness of a modified surgical corridor (ExpTSA: expanded transcanal supracochlear approach) developed for anatomic cochlear preservation in selected vestibular schwannoma patients necessitating to perform cochlear implantation for appropriate cases to achieve the best outcome. METHODS The ears of 10 cadavers (at mean age 75.70 ± 13.75 years, range 45-92 years) were dissected from the external auditory canal (EAC) to the internal auditory canal by ExpTSA under the guidance of a microscope and endoscope. All stages of the surgical process were recorded step by step and evaluated morphometrically. RESULTS The vestibular base was successfully reached in all ears without damaging the cochlear morphology and facial nerve. The vestibular base was 23.33 ± 2.02 mm away from the entrance (external orifice) and 10.26 ± 1.33 mm from the exit (internal orifice) of EAC. The oval window and vestibular base were measured to be 2.94 ± 1.05 mm and 5.87 ± 1.24 mm deep from the facial nerve, respectively. The normal areas of the oval window, the exit and entrance of EAC were found as 2.90 ± 0.81 mm2, 42.52 ± 13.66 mm2, and 110.73 ± 25.32 mm2, respectively. After ExpTSA procedure, the areas of the oval window (11.04 ± 2.83 mm2), the exit (122.45 ± 20.41 mm2) and entrance (167.49 ± 30.94 mm2) of EAC were expanded approximately 280%, 188%, and 50%, respectively. CONCLUSION The ExpTSA may be performed for accessing to the vestibule and fundus of IAC for tumor removal of intravestibular schwannoma patients (with or without fundus involvement) with unserviceable hearing, preserving the cochlear morphology.
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Affiliation(s)
- Derya Ümit Talas
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey.
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Salim Çakır
- Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
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Sporadic and NF2-associated vestibular schwannoma surgery and simultaneous cochlear implantation: a comparative systematic review. Eur Arch Otorhinolaryngol 2019; 277:333-342. [DOI: 10.1007/s00405-019-05741-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/24/2019] [Indexed: 01/11/2023]
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