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Wang K, Gjini EK, Kooper-Johnson S, Cooper MI, Gallant C, Noonan KY. Cochlear Implant Outcomes in Patients with Intralabyrinthine Schwannoma: A Scoping Review. Laryngoscope 2024; 134:3910-3920. [PMID: 38554009 DOI: 10.1002/lary.31422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To evaluate the literature and summarize cochlear implantation (CI) outcomes after intralabyrinthine schwannoma (ILS) excision and tumor observation with CI. DATA SOURCES OVID Medline, Embase, Web of Science; conception to 2024. REVIEW METHODS A literature review was performed using subject headings, MeSH terms, and keywords. Abstracts and full texts were reviewed by two independent reviewers and adjudicated by a third. Inclusion criteria included studies with ILS and CI with reported audiologic outcomes. Subjects were analyzed into two groups, ILS resection with CI and in situ ILS with CI. Patients with NF2 were included. The main outcome of interest was CI audiometric performance level, with secondary outcomes of CI user status and open-set speech attainment. RESULTS There were 29 articles with a total of 93 patients who met inclusion criteria. The resection group had 17% low performers, 44% intermediate performers, and 38% high performers. The in situ group had 40% low performers, 32% intermediate performers, 27% high performers. The resection group had 69 patients with 97% maintaining user status and 92% with open-set speech recognition. The observation group had 24 patients, with 87% user rate and 86% achieving open-set speech recognition. There was a greater percentage of NF2 diagnosis seen in the in situ group. CONCLUSION There is a paucity of literature on CI and ILS. Patients are managed with both resection of tumor and implantation in situ. Early data are limited, with improvement in hearing outcomes and high user rates in both populations. LEVEL OF EVIDENCE N/A Laryngoscope, 134:3910-3920, 2024.
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Affiliation(s)
- Katherine Wang
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Emily K Gjini
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | | | - Michael I Cooper
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Collyn Gallant
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Kathryn Y Noonan
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, U.S.A
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Bae SH, Battilocchi L, Yunbin N, Lapina G, Yun JM, Moon IS. Simultaneous cochlear implantation with early endoscopic surgery in small acoustic neuroma. Laryngoscope Investig Otolaryngol 2024; 9:e1319. [PMID: 39171093 PMCID: PMC11337909 DOI: 10.1002/lio2.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/28/2024] [Indexed: 08/23/2024] Open
Abstract
Objectives The exclusive endoscopic transcanal transpromontorial approach (EETTA) has recently been developed for the removal of small-sized acoustic neuromas in the labyrinth (intralabyrinthine schwannoma [ILS]) or internal auditory canal (IAC). Although small tumors that meet the indications for EETTA are also good candidates for cochlear implantation (CI), there are few reports on CI after schwannoma removal using EETTA. Here we present an outcome of patients who underwent simultaneous EETTA and CI. Methods Five patients (two with IAC fundus tumors and three with ILS) who underwent simultaneous EETTA and CI between 2020 and 2022 were retrospectively enrolled. Their medical charts and test results were reviewed. Results After at least 12 months of follow-up, there were no severe surgical complications such as meningitis, infection, or skin necrosis. Four of the five patients responded to auditory stimulation. Three out of four auditory-responsive patients scored >80% on sentence recognition. Conclusion Simultaneous EETTA and CI are feasible for the treatment of ILS and IAC fundus tumors. Preservation of the cochlear nerve and modiolus is important for favorable CI outcomes. Therefore, ILS and IAC fundus tumors in patients with nonserviceable hearing should be surgically removed as early as possible to enable proper hearing rehabilitation with CI. Level of Evidence Level 4.
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Affiliation(s)
- Seong Hoon Bae
- Department of OtorhinolaryngologyGangnam Severance Hospital, Yonsei University College of MedicineSeoulSouth Korea
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Nam Yunbin
- Department of OtorhinolaryngologyYonsei University College of MedicineSeoulSouth Korea
| | | | - Ji Min Yun
- Department of OtorhinolaryngologyYonsei University College of MedicineSeoulSouth Korea
| | - In Seok Moon
- Department of OtorhinolaryngologyYonsei University College of MedicineSeoulSouth Korea
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Plontke SK, Hoffmann K, Caye-Thomasen P, Baasanjav S, Kösling S, Leisz S, Liebau A, Mawrin C, Rahne T, Scheffler J, Strauss C, Siebolts U. Unilateral Multifocal Inner Ear and Internal Auditory Canal or Cerebellopontine Angle Cochleovestibular Schwannomas-Genetic Analysis and Management by Surgical Resection and Cochlear Implantation. Otol Neurotol 2024; 45:580-586. [PMID: 38437842 DOI: 10.1097/mao.0000000000004163] [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: 03/06/2024]
Abstract
OBJECTIVE To describe the genetic characteristics and the management of two very rare cases of unilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas not being associated to full neurofibromatosis type 2-related schwannomatosis. PATIENTS In a 29-year-old man and a 55-year-old woman with single-sided deafness multifocal unilateral cochleovestibular schwannomas were surgically resected, and hearing was rehabilitated with a cochlear implant (CI). Unaffected tissue was analyzed using next generation sequencing of the NF2 gene. Tumor tissue was analyzed using a 340-parallel sequencing gene panel. MAIN OUTCOME MEASURES Mutations in the NF2 gene, word recognition score for monosyllables at 65 dB SPL (WRS 65 ) with CI. RESULTS No disease-causing mutation was detected in the examined sequences in blood leucokytes. All tumor samples revealed, among others, somatic pathogenic NF2 mutations. While the anatomically separate tumors in case 1 were likely molecular identical, the tumors in case 2 showed different genetic patterns. WRS 65 was 55% at 6 years of follow-up and 60% at 4.5 years of follow-up, respectively. CONCLUSIONS The occurrence of multifocal unilateral cochleovestibular schwannomas without pathogenic variants in NF2 in non-affected blood leucocytes can be associated with mosaic NF2 -related schwannomatosis (case 1), or with likely sporadic mutations (case 2) and may be overlooked due to their extreme rarity. Although challenging, successful hearing rehabilitation could be achieved through surgical resection of the tumors and cochlear implantation.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Katrin Hoffmann
- Institute of Human Genetics, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Per Caye-Thomasen
- Department of Otorhinolaryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sevjidmaa Baasanjav
- Institute of Human Genetics, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Sandra Leisz
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Arne Liebau
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Christian Mawrin
- Institute of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Jonas Scheffler
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Germany
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AlMutawah AA, Kim T, Chung JW. Audiological Outcome of the Simultaneous Tumor Resection and Cochlear Implantation in Two Cases of Sporadic and Two Cases of Neurofibromatosis Type 2-Associated Intracochlear Schwannoma. J Clin Med 2024; 13:3042. [PMID: 38892753 PMCID: PMC11172463 DOI: 10.3390/jcm13113042] [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: 04/07/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: Simultaneous removal and cochlear implantation (CI) have been reported in intralabyrinthine and intracochlear schwannoma. A wide range of postoperative hearing outcomes have been reported after CI in these cases. This study evaluated the outcomes of performing a simultaneous resection of Schwannoma in cochlea and cochlear implantation (CI), aiming to assess the effectiveness of this combined surgical approach for hearing rehabilitation with CI. Methods: This retrospective case series was conducted at a tertiary care center. The study included four consecutive patients with profound sensorineural hearing loss due to a mass inside the cochlea. These patients underwent simultaneous single-sided CI and tumor resection performed by the same surgeon. Preoperative and postoperative audiological assessments were conducted to evaluate the patients' hearing outcomes before and after the surgical intervention. Results: Simultaneous CI with tumor resection was successful in all cases. Two of the four patients had a unilateral tumor, while the other two had a bilateral tumor with the involvement of the internal auditory canal and cerebellopontine angle (neurofibromatosis type 2 (NF2)). In two cases of unilateral tumor, aided free-field pure tone average (PTA) was 26 dB, and 46 dB hearing level (HL), and word recognition score (WRS) at 65 dB was 40% and 68%, respectively, 3 months after surgery. In two cases of tumor with NF2, aided free-field PTA was 36 dB and 60 dB HL, and both cases showed 0% WRS at 65 dB 3 months after surgery. Conclusions: Simultaneous schwannoma excision and CI in patients with Schwannoma inside cochlea are surgically practical and safe. Postoperatively, there was a notable improvement in hearing in cases of sporadic schwannoma, regardless of the type of CI used. However, there was 0% WRS in the two NF2 patients with a mass in the internal auditory canal.
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Affiliation(s)
- Abdullah A. AlMutawah
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (A.A.A.); (T.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Jahra Hospital, Ministry of Health, Jahra 00043, Kuwait
| | - Taegyeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (A.A.A.); (T.K.)
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (A.A.A.); (T.K.)
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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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Thomas M, Scheer M, Rampp S, Strauss C, Schönfeld R, Leplow B. Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery - a cross-sectional study. Int J Audiol 2024:1-8. [PMID: 38613519 DOI: 10.1080/14992027.2024.2339351] [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: 10/03/2023] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. DESIGN Cross-sectional study. STUDY SAMPLE Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman's rank-order correlations, and false discovery rate correction. RESULTS Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. CONCLUSION This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus's psychosomatic impact may enhance patients quality of life.
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Affiliation(s)
- M Thomas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scheer
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - S Rampp
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - C Strauss
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - R Schönfeld
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - B Leplow
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Hasan Z, Key S, Lee M, Da Cruz M. Systematic Review of Intracochlear Measurements and Effect on Postoperative Auditory Outcomes after Cochlear Implant Surgery. Otol Neurotol 2024; 45:e1-e17. [PMID: 38013462 DOI: 10.1097/mao.0000000000004044] [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: 11/29/2023]
Abstract
OBJECTIVE Quality and adequacy of the electrode neuron interface (ENI) is postulated to be a determining factor in affecting auditory outcomes after cochlear implantation. This study aims to review radiological parameters affecting ENI, including angular insertion (AngI), wrapping factor (WF), scalar translocation (ScaT), and electrode-modiolar distance (EMD) and their effect on auditory outcomes. DATABASES REVIEWED PubMed, MEDLINE, Embase, Scopus, OpenGrey, and Google Scholar from inception to 01 September 2022. METHODS Inclusion criteria were (i) all humans with any cochlear implant (CI); (ii) postoperative cross-sectional imaging with electrode position factors of AngI, ScaT, EMD, and/or WF; and (iii) associated auditory outcomes. Search was restricted to English-language literature. Two independent reviewers performed title and abstract screening, data extraction, and ROBINS-I risk of bias assessment. Formal statistical analysis not performed due to data heterogeneity. PROSPERO (CRD42022359198). RESULTS Thirty-one studies (n = 2,887 patients, 3,091 electrodes) underwent qualitative synthesis. Higher AngI (n = 1921 patients) demonstrated positive correlation in 11 studies, no correlation in eight studies, and negative correlation in four studies. ScaT (n = 2,115 patients) demonstrated negative correlation in 12 studies, none in six studies, and one unclear correlation. Larger EMD (n = 240 patients) showed negative correlation in two studies, no correlation in one, and unclear correlation in one study. Smaller WF (n = 369 patients) demonstrated no correlation in three studies and positive correlation in one study. CONCLUSIONS Our study finds variable reported relationship between AngI and auditory outcomes. CI electrodes with a ScaT or larger EMD are more likely to exhibit poorer outcomes, and WF does not correlate with outcomes.
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Affiliation(s)
| | - Seraphina Key
- Faculty of Medicine and Health, University of Sydney, Australia
| | - Michael Lee
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
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Carasek N, Cristovão D, Oliveira LAT, Caldas FF, Correia FM, Elias TGA, Amorim R, Bahmad Jr F. Middle Ear Cholesteatoma and Vestibular Schwannoma Resection Followed by Cochlear Implant: Surgical Challenges and Audiological Outcomes. J Clin Med 2023; 12:7139. [PMID: 38002751 PMCID: PMC10672219 DOI: 10.3390/jcm12227139] [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: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The occurrence of vestibular schwannoma (VS) associated with cholesteatoma is rare. A hearing impairment is one of the most significant issues in such cases. Moreover, the presence of middle and inner ear pathologies combined may represent a surgical challenge. No studies have described a combined surgical approach for these coexisting conditions (VS and cholesteatoma), nor the hearing rehabilitation outcomes of using cochlear implants for these patients. (2) Case Report: This paper is on a female patient who underwent simultaneous surgical treatments for VS and middle ear cholesteatoma in the right ear followed by a cochlear implant, describing the technique and the audiological results. (3) Conclusions: The surgical approach was successful and enabled the resection of lesions with the auditory nerve and cochlea preservation. Cochlear implantation in the right ear showed positive postoperative results, with an improvement in the results with the CI in silent and noisy environments.
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Affiliation(s)
- Natalia Carasek
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Danielle Cristovão
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Lucas Alves Teixeira Oliveira
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | | | - Fernando Massa Correia
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
| | | | - Rivadávio Amorim
- Faculty of Medical Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil
| | - Fayez Bahmad Jr
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
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Keles A, Ozaydin B, Erginoglu U, Baskaya MK. Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases. Brain Sci 2023; 13:1548. [PMID: 38002508 PMCID: PMC10669422 DOI: 10.3390/brainsci13111548] [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: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
The surgical management of vestibular schwannomas should be based on their presentation, neuro-imaging findings, surgeons' expertise, and logistics. Multi-stage surgery can be beneficial for large-sized lesions with acute presentations. Herein, we highlighted the indications for two cases managed initially through the retrosigmoid and, subsequently, translabyrinthine approaches. The first case presented with acute balance and gait issues and a long history of hearing loss and blurred vision. Neuroimaging findings revealed a cerebellopontine angle lesion, resembling a vestibular schwannoma, with significant brainstem compression and hydrocephalus. Due to the rapidly deteriorating clinical status and large-sized tumor, we first proceeded with urgent decompression via a retrosigmoid approach, followed by gross total resection via a translabyrinthine approach two weeks later. The second case presented with gradually worsening dizziness and hemifacial numbness accompanied by acute onset severe headaches and hearing loss. Neuroimaging findings showed a large cerebellopontine angle lesion suggestive of a vestibular schwannoma with acute intratumoral hemorrhage. Given the acute clinical deterioration and large size of the tumor, we performed urgent decompression with a retrosigmoid approach followed by gross total resection through a translabyrinthine approach a week later. Post-surgery, both patients showed excellent recovery. When managing acutely presented large-sized vestibular schwannomas, immediate surgical decompression is vital to avoid permanent neurological deficits.
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Affiliation(s)
| | | | | | - Mustafa K. Baskaya
- Department of Neurological Surgery, University of Wisconsin—Madison School of Medicine and Public Health, Madison, WI 53792, USA; (A.K.); (B.O.); (U.E.)
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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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Hosoya M, Nagaoka Y, Wakabayashi T, Shimanuki MN, Nishiyama T, Ueno M, Ozawa H, Oishi N. A novel intraoperative continuous monitoring method combining dorsal cochlear nucleus action potentials monitoring with auditory nerve test system. J Otolaryngol Head Neck Surg 2023; 52:67. [PMID: 37803428 PMCID: PMC10557301 DOI: 10.1186/s40463-023-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Highly accurate real-time cochlear nerve monitoring to preserve cochlear nerve function is essential for simultaneous cochlear implantation and ipsilateral vestibular schwannoma resection. In the present study, we developed a novel real-time monitoring system that combines dorsal cochlear nucleus action potential monitoring with intracochlear stimulating electrodes (Auditory Nerve Test System, ANTS). We used this system for a case with vestibular schwannoma resection via the translabyrinthine approach. The monitoring system developed in this study detected highly reliable evoked potentials from the cochlear nerve every two seconds continuously during tumor resection. Near-total tumor resection was achieved, and cochlear implantation was performed successfully after confirming the preservation of cochlear nerve function in a case. The patient's hearing was well compensated by cochlear implantation after surgery. Our novel method continuously achieved real-time monitoring of the cochlear nerve every two seconds during vestibular schwannoma resection. The usefulness of this monitoring system for simultaneous tumor resection and cochlear implantation was demonstrated in the present case. The system developed in this study is compatible with continuous facial nerve monitoring. This highly accurate and novel monitoring method will broaden the number of candidates for this type of surgery in the future.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuriko Nagaoka
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Marie N Shimanuki
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masafumi Ueno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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12
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Ha J, Kim H, Gu GY, Song YJ, Jang JH, Park HY, Choung YH. Surgical Outcomes of Simultaneous Cochlear Implantation and Intracochlear Schwannoma Removal. Otolaryngol Head Neck Surg 2023; 169:660-668. [PMID: 36807253 DOI: 10.1002/ohn.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/06/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Intracochlear schwannoma is very rare, and complete loss of hearing is inevitable after the removal of this tumor. Here, we discuss cochlear implantation (CI) performed simultaneously with the removal of an intracochlear schwannoma. STUDY DESIGN Retrospective single-center study. SETTING Tertiary medical institute. METHODS Simultaneous CI and intracochlear schwannoma removal were performed in 4 subjects. After subtotal cochleostomy, the tumors were removed meticulously, with preservation of the modiolus. A new slim modiolar electrode (Nucleus CI632) was placed in a manner that hugged the modiolus. The surgical outcomes of functional gain, word recognition score (WRS), sound localization, and hearing in noise and speech intelligibility tests were investigated. RESULTS Intracochlear schwannomas were removed successfully from the 4 patients, with no remnant tumor. The mean aided hearing threshold 6 months after surgery was 25.0 ± 1.8 dB, and the mean-aided WRS with a 60 dB stimulus was 36.0 ± 18.8% (range 16%-60%). The Categorical Auditory Performance (CAP) score of the 3 single-sided deafness patients under contralateral ear masking was 7. The CAP score of the patient with bilateral sensorineural hearing loss was 6, which improved from a preoperative score of 0. CONCLUSION When an intracochlear schwannoma does not completely invade the modiolus, CI with simultaneous tumor removal can be performed successfully, resulting in good hearing performance. A slim modiolar electrode can be placed stably at the modiolus after schwannoma removal.
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Affiliation(s)
- Jungho Ha
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Hantai Kim
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Ga Young Gu
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Young Jae Song
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
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13
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Choi JS, Fritz CG, Babu KC, Fan CJ, Babu SC. Simultaneous Cochlear Implantation and Salvage Translabyrinthine Resection of Vestibular Schwannoma after Radiotherapy. Otol Neurotol 2023; 44:00129492-990000000-00276. [PMID: 37185373 DOI: 10.1097/mao.0000000000003868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To report on the novel use of simultaneous cochlear implantation (CI) during salvage translabyrinthine resection of vestibular schwannoma (VS) after failed stereotactic radiosurgery (SRS). PATIENT A 52-year-old woman presented with a medium-sized right VS. She experienced continued tumor growth despite previous SRS, resulting in medial extension beyond the internal auditory canal into the cerebellopontine angle. Associated symptoms included asymmetrical right moderate to severe sensorineural hearing loss, poor word recognition, tinnitus, and dizziness. INTERVENTION Simultaneous CI with translabyrinthine VS resection. MAIN OUTCOME MEASURE CI-aided pure-tone averages. RESULTS After 4 months of device use, CI-aided speech audiometry revealed hearing thresholds in the normal range, with a four-tone pure-tone, average of 16.3 dB. Speech perception with consonant-nucleus-consonant testing in the CI-only condition was 46%, representing a 12% improvement compared with preoperatively. Tinnitus and dizziness burden were subjectively reduced. CONCLUSIONS Despite challenges inherent to second procedures after radiotherapy failure, successful CI outcomes can be achieved. The current study demonstrates the feasibility of simultaneous CI during salvage VS resection after SRS. A larger study should be undertaken to further substantiate these preliminary findings.
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Affiliation(s)
| | | | - Kavan C Babu
- Michigan Ear Institute, Farmington Hills, Michigan
| | - Caleb J Fan
- Michigan Ear Institute, Farmington Hills, Michigan
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14
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Mankekar G, Holmes S. Hearing Rehabilitation in Vestibular Schwannoma. Audiol Res 2023; 13:357-366. [PMID: 37218842 DOI: 10.3390/audiolres13030031] [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: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology, Louisiana State Health University Sciences Center, Shreveport, LA 71103, USA
| | - Sean Holmes
- Department of Otolaryngology, Cox Health Medical Group, Springfield, MO 35807, USA
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15
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Zhan KY, Wick CC. Intraoperative Cochlear Nerve Monitoring in Vestibular Schwannoma Microsurgery. Otolaryngol Clin North Am 2023; 56:471-482. [PMID: 36964094 DOI: 10.1016/j.otc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Monitoring the cochlear nerve during vestibular schwannoma (VS) microsurgery depends on the hearing status and surgical approach. Traditional hearing preservation VS microsurgery relies on acoustically driven auditory brainstem response (ABR) and cochlear nerve action potential. Both modalities have advantages and disadvantages that need to be understood for proper implementation. When hearing is lost or the approach violates the otic capsule, electrically evoked monitoring methods may be used. Evoked ABR (eABR) is feasible and safe but may be limited by artifact. Combining eABR with near-field measures such as electrocochleography or neural telemetry shows promise.
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Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology-Head & Neck Surgery, Washington University, St Louis, MO, USA
| | - Cameron C Wick
- Department of Otolaryngology-Head & Neck Surgery, Washington University, St Louis, MO, USA.
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16
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Schwam ZG, Cosetti MK, Wanna GB. Translabyrinthine Approach for Sporadic Vestibular Schwannoma: Patient Selection, Technical Pearls, and Patient Outcomes. Otolaryngol Clin North Am 2023; 56:483-493. [PMID: 36964096 DOI: 10.1016/j.otc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Herein we briefly describe the translabyrinthine approach to vestibular schwannoma resection as well as a focused literature review as to the best candidates, technical recommendations, and key outcomes with respect to other approaches.
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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17
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How Cochlear Implant Rehabilitation Impacts the Therapeutic Strategy for Vestibular Schwannoma. Audiol Res 2023; 13:116-129. [PMID: 36825950 PMCID: PMC9952590 DOI: 10.3390/audiolres13010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Since both surgery and more conservative treatments show long-term outcomes in patients with VS, the current challenge in its therapeutic strategy is to offer a cure with lower functional morbidity in terms of facial and hearing preservation or the possibility of hearing rehabilitation with a cochlear implant. METHODS PubMed and Scopus databases were searched from 2017 to November 2022. Fifteen articles met our selection criteria: (1) patients with a diagnosis of VS, either sporadic or NF2-related; (2) simultaneous or sequential cochlear implantation; (3) specified audiological test results and follow-up timing. CONCLUSIONS Although the level of evidence for the presently included studies is low due to either the study design or the lack of treatment consensus, CI rehabilitation is a promising option, especially in small VS with compromised hearing and as a salvage option after a failed attempt at hearing preservation surgery.
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18
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Doerfer KW, Fritz CG, Porps SL, Hong RS, Jacob JT, Babu SC. Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Otolaryngol Head Neck Surg 2023. [PMID: 36939583 DOI: 10.1002/ohn.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period. RESULTS AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. CONCLUSION Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.
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Affiliation(s)
- Karl W Doerfer
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian G Fritz
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Sandra L Porps
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Robert S Hong
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Jeffrey T Jacob
- Division of Skull Base Surgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
| | - Seilesh C Babu
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
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19
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Gadenstaetter AJ, Auinger AB, Gerlitz M, Riss D, Dahm V, Yildiz E, Roessler K, Matula C, Arnoldner C. Functional Outcome After Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation With Intraoperative Cochlear Nerve Monitoring. Otolaryngol Head Neck Surg 2023; 168:1502-1510. [PMID: 36856581 DOI: 10.1002/ohn.233] [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: 08/29/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Electrically evoked auditory brainstem response audiometry has emerged as a suitable option to intraoperatively assess cochlear nerve function during vestibular schwannoma resection. This study aimed to analyze the functional outcome and implant usage of patients with preserved auditory nerve responses after simultaneous translabyrinthine schwannoma resection and cochlear implantation. STUDY DESIGN Prospective study. SETTING Tertiary referral center. METHODS Patients with unilateral sporadic vestibular schwannoma underwent translabyrinthine tumor resection. Intraoperatively, electrically evoked auditory brainstem response audiometry was performed before and after tumor removal. Cochlear implantation was carried out if positive responses were detected after tumor removal indicating cochlear nerve function. Postoperatively, patients were biannually followed-up to assess aided sound field audiometry and word recognition as well as implant usage. RESULTS Overall, 26 patients with vestibular schwannoma underwent translabyrinthine schwannoma resection. Out of these patients, 15 had positive cochlear nerve responses after tumor removal and concurrently received a cochlear implant. In 13 patients with histologically confirmed vestibular schwannoma, hearing improved by 23.7 ± 33.2 decibels and word recognition by 25.0 ± 42.4% over a mean follow-up period of 18 months. Overall, 12 included patients were regular cochlear implant users. CONCLUSION Patients with vestibular schwannoma can benefit substantially from cochlear implantation. Intraoperative assessment of cochlear nerve function using electrically evoked auditory brainstem response audiometry can help to better identify individuals eligible for simultaneous vestibular schwannoma resection and cochlear implantation.
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Affiliation(s)
- Anselm Joseph Gadenstaetter
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Alice Barbara Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias Gerlitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Valerie Dahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Matula
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Dallari V, Apa E, Monzani D, Genovese E, Marchioni D, Soloperto D, Sacchetto L. Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series. Audiol Res 2022; 13:1-11. [PMID: 36648922 PMCID: PMC9844357 DOI: 10.3390/audiolres13010001] [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: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Cochlear implantation (CI) following endoscopic transcanal infrapromontorial vestibular schwannoma (VS) dissection is a feasible intervention in intracanalicular VS, with minimal extension into the cerebellopontine angle, but no audiologic results have ever been reported in the literature. Methods: From 2015 to 2021 in the Otorhynolaryngology Departments of Modena and Verona, three patients underwent this intervention. All were suffering from sporadic left-sided intracanalicular Koos I VS. Intraoperative electrically evoked auditory brainstem responses and electrophysiological measurements were performed before and after the placement of the electrode array, respectively. Since device activation one month after the surgery, each patient was followed up with audiometric tests, data logging, electrode impedance measurements and neural response telemetry performed at each scheduled fitting session at 15 days and 3, 6, 12 and 24 months. Results: Only in patient No. 3, an auditory benefit was observed and still evident even 36 months after activation. Impedances increased progressively in patient No. 1 and a benefit was never reported. Patient No. 2 left the follow-up for worsening comorbidities. Conclusions: CI following transcanal infrapromontorial VS resection is a beneficial intervention. The residual cochlear nerve after the tumour dissection and the course of electrophysiological measurements in the postoperative period were the main predictive factors for audiological outcomes.
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Affiliation(s)
- Virginia Dallari
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Borgo Roma Hospital, University of Verona, 37134 Verona, Italy
| | - Enrico Apa
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence:
| | - Daniele Monzani
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Borgo Roma Hospital, University of Verona, 37134 Verona, Italy
| | - Elisabetta Genovese
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Daniele Marchioni
- Department of Medical and Surgical Sciences for Children and Adults, Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Davide Soloperto
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Borgo Roma Hospital, University of Verona, 37134 Verona, Italy
| | - Luca Sacchetto
- Section of Ear, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Borgo Roma Hospital, University of Verona, 37134 Verona, Italy
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Cochlear implantation: an effective modality for hearing restoration following vestibular schwannoma resection. Curr Opin Otolaryngol Head Neck Surg 2022; 30:309-313. [PMID: 36036530 DOI: 10.1097/moo.0000000000000844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Preservation of hearing is one of the tenets of vestibular schwannoma management. In recent years, cochlear implants have been employed with increasing use in patients who have suffered profound sensorineural hearing loss due to the natural history of vestibular schwannoma or due to injury to neurovascular anatomy at time of surgical resection. RECENT FINDINGS Cochlear implantation has been found to be an effective modality for hearing restoration following vestibular schwannoma. Simultaneous cochlear implantation has been employed by an increased number of centers around the world and has been shown to provide restoration of open set speech perception and return of binaural hearing. Ongoing use of electrically evoked auditory brainstem response (ABR) has improved our detection of viable cochlear nerves and provided insight into those who would benefit from this procedure. Finally, minimally invasive approaches to the internal auditory canal and intralabyrinthine tumors have been described. These methods frequently employ simultaneous cochlear implantation and have emphasized that hearing preservation remains possible with surgical excision despite the location of the tumor. SUMMARY Cochlear implantation is an effective modality for hearing restoration following vestibular schwannoma excision.
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22
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Cochlear Implantation Outcomes in Patients With Retrocochlear Pathology: A Systematic Review and Pooled Analysis. Otol Neurotol 2022; 43:980-986. [PMID: 36047686 DOI: 10.1097/mao.0000000000003648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review the current literature regarding cochlear implantation in patients with retrocochlear pathologies and extract speech perception scores between 6 months and 1 year after surgery. DATABASES REVIEWED PubMed/MEDLINE, Embase and Cochrane CENTRAL via Ovid, CINAHL Complete via Ebsco, and Web of Science. METHODS The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search strategies included keywords and subject headings to maximize retrieval and reflect cochlear implants and retrocochlear pathologies. Patients with previously resected vestibular schwannoma (VS) were excluded. RESULTS There were 2,524 abstracts screened against inclusion criteria, and 53 studies were included, with individual data available for 171 adult patients. Pathologies included were either observed or irradiated VS (previously operated tumors were excluded) (n = 99, 57.9%), superficial siderosis (n = 39, 22.8%), neurosarcoidosis (n = 11, 6.4%), and previous central nervous system or skull base radiation (n = 22, 12.9%). Mean (standard deviation) postoperative consonant-nucleus-consonant (CNC) word scores were 45.4% (24.2) for observed VS, 44.4% (20.8) for irradiated VS, 43.6% (21.0) for superficial siderosis, 89.5% (3.0) for neurosarcoidosis, and 30.0% (30.2) in patients with previous central nervous system or skull base irradiation. Irradiated compared with observed VS had similar postoperative CNC word scores (effect size, 0.06; p = 0.71). Age, sex, maximal tumor dimension, and neurofibromatosis type 2 status did not significantly impact cochlear implant performance in patients with VS. Eighty-two percent of patients with reported device usage were daily users, and overall, 82% of cases benefitted from cochlear implantation. CONCLUSION Cochlear implantation in patients with concomitant retrocochlear pathology generally results in improved speech discrimination scores sustained over time.
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Is the intra-operative morphology of the cochlear nerve a good predictor of the results of simultaneous ipsilateral cochlear implantation in vestibular schwannoma surgery? J Laryngol Otol 2022:1-6. [PMID: 36117333 DOI: 10.1017/s0022215122002079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are currently no guidelines for simultaneous vestibular schwannoma surgery and cochlear implantation. This paper therefore provides our experience and our results regarding predictive parameters of good hearing. METHODS Morphological appearance of the cochlear nerve after tumour resection was used as the main criterion for implantation in the case series. Patients were then divided into responders and non-responders to cochlear implantation, and potential outcome predicting factors were evaluated in the two groups. RESULTS Nine of the 16 patients showed a response to cochlear implantation. Pre-surgery serviceable hearing was significantly more common in the responder group, while no difference was found in the two groups for other variables. CONCLUSION This study highlights how the morphological appearance of the cochlear nerve can be useful to predict the hearing outcome and indicates that satisfactory hearing results are closely related to pre-surgery serviceable hearing.
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Understanding the Molecular Mechanism of Vestibular Schwannoma for Hearing Preservation Surgery: Otologists’ Perspective from Bedside to Bench. Diagnostics (Basel) 2022; 12:diagnostics12051044. [PMID: 35626200 PMCID: PMC9140016 DOI: 10.3390/diagnostics12051044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Vestibular schwannoma is a clinically benign schwannoma that arises from the vestibulocochlear nerve that causes sensorineural hearing loss. This tumor is clinically and oncologically regarded as a benign tumor as it does not metastasize or invade surrounding tissues. Despite being a benign tumor, its management is difficult and controversial due to the potential serious complications, such as irreversible sensorineural hearing loss, of current interventions. Therefore, preventing hearing loss due to the natural course of the disease and complications of surgery is a challenging issue for an otologist. Improvements have been reported recently in the treatment of vestibular schwannomas. These include advances in intraoperative monitoring systems for vestibular schwannoma surgery where the risk of hearing loss as a complication is decreased. Precise genomic analysis of the tumor would be helpful in determining the characteristics of the tumor for each patient, leading to a better hearing prognosis. These procedures are expected to help improve the treatment of vestibular schwannomas. This review summarizes recent advances in vestibular schwannoma management and treatment, especially in hearing preservation. In addition, recent advances in the understanding of the molecular mechanisms underlying vestibular schwannomas and how these advances can be applied in clinical practice are outlined and discussed, respectively. Moreover, the future directions from the bedside to the bench side are presented from the perspective of otologists.
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Woodun H, Woodun H, Vedachalam RV, Fassihi H, Achar P. Bilateral cochlear implantation in a young patient with xeroderma pigmentosum (XP-D) and progressive sensorineural hearing loss-How to do it? J Surg Case Rep 2022; 2022:rjab594. [PMID: 35047178 PMCID: PMC8759561 DOI: 10.1093/jscr/rjab594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
Xeroderma pigmentosum (XP), a rare genetic skin condition, causes ultraviolet (UV)-induced neoplasms and possible neurological deficits including sensorineural hearingloss. We present the first case in literature of bilateral cochlear implantation (CI) in a patient with XP-D with neurodegeneration. Multi-disciplinary team members (national XP team, dermatologist, anaesthetist, theatre team, biophysicists) were involved. UV exposure from equipment and areas where the 14-year-old patient would track was measured. Maximum possible surgery was performed under operating headlights to limit higher-UV microscope exposure. Its bulb light intensity was reduced to achieve safe UV level (0–10 μW/cm2). Skin was protected under surgical drapes. Challenges included drilling unpredicted hard thick bone under low-intensity light and requiring bulkier Nucleus®-7 processor due to unanticipated increased scarring. A delayed left facial weakness was resolved with steroids. He is undergoing hearing rehabilitation. This highlights challenges of CI in XP. Its impact in preserving cognition and on neurodegeneration should also be observed.
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Affiliation(s)
- H Woodun
- Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - H Woodun
- Department of Otorhinolaryngology, Lincoln County Hospital, Lincoln LN2 5QY, UK
| | | | - H Fassihi
- Consultant Dermatologist and Clinical Lead for National XP Service, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EP, UK
| | - P Achar
- Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Wallerius KP, Macielak RJ, Lawlor SK, Lohse CM, Neff BA, Van Gompel JJ, Driscoll CLW, Link MJ, Carlson ML. Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in "Larger" Tumors? Laryngoscope 2021; 132:1657-1664. [PMID: 34854492 DOI: 10.1002/lary.29968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS To review hearing preservation after microsurgical resection of sporadic vestibular schwannomas according to tumor size. STUDY DESIGN Retrospective cohort. METHODS Baseline, intraoperative, and postoperative patient and tumor characteristics were retrospectively collected for a cohort who underwent hearing preservation microsurgery. Serviceable hearing was defined by a pure tone average ≤50 dB and word recognition score ≥50%. RESULTS A total of 243 patients had serviceable hearing preoperatively. Fifty (21%) tumors were confined to the internal auditory canal, and the median tumor size was 16.2 mm (interquartile range [IQR] 11.3-23.2) for tumors with cerebellopontine angle extension. Serviceable hearing was maintained in 64% of patients with tumors confined to the internal auditory canal, 28% with cerebellopontine angle extension <15 mm, and 9% with cerebellopontine angle extension ≥15 mm. On multivariable analysis, the odds ratios of acquiring nonserviceable hearing postoperatively for tumors extending <15 mm and ≥15 mm into the cerebellopontine angle were 5.75 (95% confidence interval [CI] 2.13-15.53; P < .001) and 22.11 (95% CI 7.04-69.42; P < .001), respectively, compared with intracanalicular tumors. CONCLUSIONS The strongest predictor of hearing preservation with microsurgery after multivariable adjustment is tumor size. Approximately 10% of patients with tumors ≥15 mm of cerebellopontine angle extension will retain serviceable hearing after microsurgery. Furthermore, hearing preservation techniques offer cochlear nerve preservation and cochlear patency allowing for possible future cochlear implantation. An attempt at hearing preservation, including avoiding surgical approaches that necessarily sacrifice hearing, is worthwhile even in larger tumors if serviceable hearing is present preoperatively. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Katherine P Wallerius
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Robert J Macielak
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Skye K Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Scala MR, Spennato P, Volpe AD, Santoro C, Picariello S, Varricchio AM, Ruggiero C, dé Santi S, Cinalli G. Removal of Koos IV acoustic neuroma and auditory brainstem implant in NF2 patient. NEUROSURGICAL FOCUS: VIDEO 2021; 5:V16. [PMID: 36285234 PMCID: PMC9550011 DOI: 10.3171/2021.7.focvid2188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
The authors present the case of removal of a Koos grade IV right acoustic neuroma in a neurofibromatosis type 2 (NF2) patient, already operated on for left cerebellopontine angle meningioma at 7 years of age and a left acoustic neuroma at 16 years of age. A transpetrosal approach allowed cochlear sensor implantation to detect residual hearing. An enlarged retrosigmoid approach then allowed subtotal microsurgical removal of the lesion; consequently, the authors illustrate the technical nuances of an auditory brainstem implant (ABI). One month after surgery, the ABI was successfully switched on, giving back hearing perception to the patient. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2188.
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Affiliation(s)
| | | | - Antonio Della Volpe
- Otology and Cochlear Implant Unit, Santobono-Pausilipon Children’s Hospital, Naples
| | - Claudia Santoro
- Neurofibromatosis Referral Centre, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples; and
- Departments of Physical and Mental Health, and Preventive Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Stefania Picariello
- Neurofibromatosis Referral Centre, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples; and
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Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation. Brain Sci 2021; 11:brainsci11091221. [PMID: 34573240 PMCID: PMC8466831 DOI: 10.3390/brainsci11091221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. Methods: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. Results: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. Conclusion: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion.
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Gan J, Zhang Y, Wu J, Lei D, Zhang F, Zhao H, Wang L. Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review. Front Oncol 2021; 11:687201. [PMID: 34476211 PMCID: PMC8406761 DOI: 10.3389/fonc.2021.687201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Hearing loss is the most common initial symptom in patients with sporadic vestibular schwannomas (SVS). Hearing preservation is an important goal of both conservative and surgical therapy. However, the mechanism of SVS-associated hearing loss remains unclear. Thus, we performed this systematic review to summarize the current understanding of hearing loss in the SVS and distill a testable hypothesis to further illuminate its underlying mechanism. Methods A systematic review querying four databases (PubMed, Medline, Embase, and Web of Science) was performed to identify studies evaluating hearing loss in patients with SVS and exploring the potential mechanisms of hearing impairment. Results A total of 50 articles were eligible and included in this review. After analysis, the retrieved studies could be categorized into four types: (1) 29 studies explore the relationship between hearing loss and the growth pattern of the tumor (e.g., tumor size/volume, growth rate, tumor location, etc.); (2) ten studies investigate the potential role of cochlear dysfunction in hearing deterioration, including structural abnormality, protein elevation in perilymph, and cochlear malfunctioning; (3) two studies looked into SVS-induced impairment of auditory pathway and cortex; (4) in the rest nine studies, researchers explored the molecular mechanism underlying hearing loss in SVS, which involves molecular and genetic alterations, inflammatory response, growth factors, and other tumor-associated secretions. Conclusions Multiple factors may contribute to the hearing impairment in SVS, including the growth pattern of tumor, cochlear dysfunction, impairment of auditory pathway and cortex, genetic and molecular changes. However, our current understanding is still limited, and future studies are needed to explore this multifactorial hypothesis and dig deeper into its underlying mechanism.
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Affiliation(s)
- Jinlu Gan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingnan Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deqiang Lei
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangcheng Zhang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Holmes S, Lalwani AK, Mankekar G. Is Cochlear Implantation Effective for Auditory Rehabilitation Following Vestibular Schwannoma Treatment? Laryngoscope 2021; 132:1140-1141. [PMID: 34415077 DOI: 10.1002/lary.29836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sean Holmes
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A
| | - Anil K Lalwani
- Division of Otology, Neurotology, and Skull Base Surgery, Columbia University Vagelos College of Physicians and Surgeons, and New York Presbyterian - Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Gauri Mankekar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A
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Butler MJ, Wick CC, Shew MA, Chicoine MR, Ortmann AJ, Vance J, Buchman CA. Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:324-331. [PMID: 34332508 DOI: 10.1093/ons/opab274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) often results in profound hearing loss and cochlear implantation is an emerging hearing rehabilitation option. However, cochlear implant (CI) outcomes in this population vary, and intraoperative monitoring to predict cochlear nerve viability and subsequent outcomes is not well-established. OBJECTIVE To review the use of intraoperative electrically evoked cochlear nerve monitoring in patients with NF2 simultaneous translabyrinthine (TL) vestibular schwannoma (VS) resection and cochlear implantation. METHODS A retrospective review was performed of 3 patients with NF2 that underwent simultaneous TL VS resection and cochlear implantation with electrical auditory brainstem response (eABR) measured throughout tumor resection. Patient demographics, preoperative assessments, surgical procedures, and outcomes were reviewed. RESULTS Patients 1 and 3 had a reliable eABR throughout tumor removal. Patient 2 had eABR pretumor removal, but post-tumor removal eABR presence could not be reliably determined because of electrical artifact interference. All patients achieved auditory percepts upon CI activation. Patients 1 and 2 experienced a decline in CI performance after 1 yr and after 3 mo, respectively. Patient 3 continues to perform well at 9 mo. Patients 2 and 3 are daily users of their CI. CONCLUSION Cochlear implantation is attainable in cases of NF2-associated VS resection. Intraoperative eABR may facilitate cochlear nerve preservation during tumor removal, though more data and long-term outcomes are needed to refine eABR methodology and predictive value for this population.
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Affiliation(s)
- Margaret J Butler
- Program in Audiology and Communication Sciences, Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cameron C Wick
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew A Shew
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amanda J Ortmann
- Program in Audiology and Communication Sciences, Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janet Vance
- Saint Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Craig A Buchman
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Conway RM, Tu NC, Sioshansi PC, Porps SL, Schutt CA, Hong RS, Jacob JT, Babu SC. Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Laryngoscope 2021; 131:E2312-E2317. [PMID: 33851722 DOI: 10.1002/lary.29436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS Hearing rehabilitation after translabyrinthine resection of a vestibular schwannoma (VS) has largely been based on the transfer of acoustic stimulus to the contralateral ear, typically through a contralateral routing of signal hearing aid or bone-anchored hearing aid (BAHA). Cochlear implant, either as a subsequent surgery or simultaneously, has become a more common treatment option; however, there is still relatively limited data available on its success. The purpose of this study is to evaluate the early outcomes of simultaneous cochlear implantation in patients with sporadic VS undergoing translabyrinthine resection. STUDY DESIGN Prospective, nonrandomized study. METHODS A prospective study of nonrandomized patients was completed at a tertiary care neurotology center. Audiologic outcomes, primarily based on AzBIO in quiet and background noise, as well as consonant-nucleus-consonant (CNC) testing of the affected ears were utilized. Tinnitus, dizziness, and spatial hearing questionnaries were also completed. Audiologic outcomes and questionnaires were compared between the pre- and postoperative groups. RESULTS Ten patients were included in the study with 3 month follow-up data. There was statistically significant improvement in AzBO with +10 and +5 signal to noise ratio and in quiet, as well as in CNC testing (P < .05). There was a significant improvement in Tinnitus Handicap Inventory between the two groups. CONCLUSIONS Simultaneous cochlear implantation is a viable treatment for hearing loss after translabyrinthine approach to VS. These patients have improved hearing in background noise and tinnitus compared to their preoperative state. Further prognostic data are required to determine which patients are the best candidates. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2312-E2317, 2021.
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Affiliation(s)
- Robert M Conway
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, Michigan, USA
| | - Nathan C Tu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | | | | | | | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
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Affiliation(s)
- Matthew L Carlson
- From the Departments of Otolaryngology-Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Michael J Link
- From the Departments of Otolaryngology-Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, MN
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