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Pontillo V, Foscolo V, Salonna F, Barbara F, Bozzi MT, Messina R, Signorelli F, Quaranta NAA. Hearing preservation surgery for vestibular schwannoma: a systematic review and meta-analysis. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S86-S93. [PMID: 38745520 PMCID: PMC11098544 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
The aim of this systematic review is to analyse the role of hearing preservation surgery for vestibular schwannoma. The complications and hearing outcomes of the single surgical techniques were investigated and compared with those of less invasive strategies, such as stereotactic radiotherapy and wait and scan policy. This systematic review and meta-analysis was performed according to the PRISMA guidelines. All included studies were published in English between 2000 and 2022. Literature data show that hearing preservation is achieved in less than 25% of patients after surgery and in approximately half of cases after stereotactic radiotherapy, even if data on long-term preservation are currently not available.
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Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Valentina Foscolo
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Salonna
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Barbara
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Maria Teresa Bozzi
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Raffaella Messina
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Nicola Antonio Adolfo Quaranta
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
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Gu F, Yang X, Wang Z, Tan X, Xue T, Chen Z, Wang Z, Chen G. Diagnostic accuracy of intraoperative brainstem auditory evoked potential for predicting hearing loss after vestibular schwannoma surgery. Front Neurol 2022; 13:1018324. [PMID: 36588877 PMCID: PMC9797509 DOI: 10.3389/fneur.2022.1018324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This meta-analysis evaluated the diagnostic value of intraoperative brainstem auditory evoked potential (BAEP) for predicting post-operative hearing loss. Methods Research articles in MEDLINE, Embase, and Cochrane Library databases were searched and selected up to 20 January 2022, and data were extracted following a standard procedure. A diagnostic accuracy test meta-analysis was performed using a mixed-effect binary regression model. Results A total of 693 patients from 15 studies were extracted. The change in intraoperative BAEP showed high sensitivity (0.95) but low specificity (0.37), with an area under the curve of 0.83. Diagnostic accuracy of the loss of potentials showed high sensitivity (0.82) and specificity (0.79). The area under the curve was 0.88. No factor was found to account for the heterogeneity of the results according to the meta-regression and subgroup analyses (all P-values > 0.05). Conclusions Our results showed that the loss of BAEP has meaningful value for predicting hearing loss after vestibular schwannoma surgery. The change in BAEP is also important for its high sensitivity during hearing preservation surgery.
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Affiliation(s)
- Feng Gu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Tan
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Zhouqing Chen
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,*Correspondence: Zhong Wang
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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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: 0] [Impact Index Per Article: 0] [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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When Does Hearing Loss Occur in Vestibular Schwannoma Surgery? Importance of Auditory Brainstem Response Changes in Early Postoperative Phase. World Neurosurg 2016; 95:91-98. [PMID: 27495840 DOI: 10.1016/j.wneu.2016.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Some patients suffer postoperative hearing loss even when the intraoperative auditory brainstem response (ABR) is preserved during vestibular schwannomas surgery. This study was conducted to evaluate whether there are dynamic changes of the ABR after surgery. PATIENTS AND METHODS In a prospective study from 2010-2012, 46 patients (24 female and 22 male) with vestibular schwannomas were investigated by intraoperative and postoperative ABR monitoring. Development of ABR quality during and after surgery (Class 1 normal, Class 5 complete loss) was correlated to auditory outcome. RESULTS At the end of surgery, 17 patients had an ABR Class 1-4 and 29 had Class 5. Four hours after surgery, 9 of 23 (39%) patients showed an ABR quality change, and 24 hours after surgery, 15 of 30 (50%) had undergone ABR quality changes. Four different types of postoperative ABR courses could be distinguished-Course 1: stable with reproducible ABR, Course 2: unstable with reproducible ABR, Course 3: unstable with ABR loss, and Course 4: stable with ABR loss. These courses correlated highly significantly with the intraoperative development (P < 0.001) and with hearing outcome (P = 0.003). CONCLUSION The study identifies ongoing changes of ABR quality and hearing function after the end of vestibular schwannoma surgery. Therefore it seems worthwhile to continue ABR monitoring in the postoperative phase in order to identify patients who are at risk of a secondary hearing deterioration and start therapeutic interventions in a timely manner.
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Oh T, Nagasawa DT, Fong BM, Trang A, Gopen Q, Parsa AT, Yang I. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas. Neurosurg Focus 2013; 33:E6. [PMID: 22937857 DOI: 10.3171/2012.6.focus12194] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection.
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Affiliation(s)
- Taemin Oh
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-1761, USA
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Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Régis J. HEARING PRESERVATION AFTER GAMMA KNIFE RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS PRESENTING WITH HIGH-LEVEL HEARING. Neurosurgery 2009; 64:289-96; discussion 296. [DOI: 10.1227/01.neu.0000338256.87936.7c] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The aim of this study was to evaluate long-term hearing preservation after gamma knife radiosurgery (GKS) for vestibular schwannomas in patients with initially normal or subnormal hearing (Gardner-Robertson Class 1) and to determine the predictive factors for functional hearing preservation.
METHODS
Since July 1992, more than 2053 vestibular schwannomas have been treated by GKS and followed at the Timone University Hospital, Marseille. A minimum of 3 years of follow-up (range, 3–11 years; median, 48 months) is available for 74 patients (without neurofibromatosis Type 2 or previous surgery) with Gardner-Robertson Class 1 hearing.
RESULTS
The average age of the patients was 47.5 years (range, 17–76 years). The number of tumors in Koos Stage I was 8, the average number in Stage II was 21, the average number in Stage III was 43, and the average number in Stage IV was 2. The median number of isocenters was 8 (range, 2–45), and the median marginal dose was 12 Gy (range, 9–13 Gy). At the time of the last follow-up evaluation, 78.4% of the patients had preserved functional hearing. Tumor control was achieved in 93% of the cases. The probability of preserving functional hearing was higher in patients who had an initial symptom other than hearing decrease (91.1%), in patients younger than 50 years (83.7%), and in those treated with a dose to the cochlea of less than 4 Gy (90.9%).
CONCLUSION
This study shows that the probability of preserving functional hearing in the long term after GKS for patients presenting with unilateral vestibular schwannomas is very high. The positive predictive factors appear to be young age, an initial symptom other than hearing decrease, and a low dose to the cochlea.
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Affiliation(s)
- Manabu Tamura
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Romain Carron
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Shoji Yomo
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Yasser Arkha
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Xavier Muraciolle
- Department of Radiation Oncology, Hôpital de la Timone, Marseille, France
| | - Denis Porcheron
- Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Jean M. Thomassin
- Department of Ear, Nose, and Throat Surgery, Hôpital de la Timone, Marseille, France
| | - Pierre H. Roche
- Department of Neurosurgery, Hôpital de la Timone, Marseille, France
| | - Jean Régis
- Department of Stereotactic and Functional Neurosurgery, INSERM, U751, Aix Marseille II Université, Hôpital de la Timone, Marseille, France
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Strauss C, Bischoff B, Neu M, Berg M, Fahlbusch R, Romstöck J. Vasoactive treatment for hearing preservation in acoustic neuroma surgery. J Neurosurg 2001; 95:771-7. [PMID: 11702866 DOI: 10.3171/jns.2001.95.5.0771] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Delayed hearing loss following surgery for acoustic neuroma indicates anatomical and functional preservation of the cochlear nerve and implies that a pathophysiological mechanism is initiated during surgery and continues thereafter. Intraoperative brainstem auditory evoked potentials (BAEPs) typically demonstrate gradual reversible loss of components in these patients. METHODS Based on this BAEP pattern, a consecutive series of 41 patients with unilateral acoustic neuromas was recruited into a prospective randomized study to investigate hearing outcomes following the natural postoperative course and recuperation after vasoactive medication. Both groups were comparable in patient age, tumor size, and preoperative hearing level. Twenty patients did not receive postoperative medical treatment. In 70% of these patients anacusis was documented and in 30% hearing was preserved. Twenty-one patients were treated with hydroxyethyl starch and nimodipine for an average of 9 days. In 66.6% of these patients hearing was preserved and in 33.3% anacusis occurred. CONCLUSIONS These results are statistically significant (p < 0.05, chi2 = 5.51) and provide evidence that these surgically treated patients suffer from a disturbed microcirculation that causes delayed hearing loss following removal of acoustic neuromas.
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Affiliation(s)
- C Strauss
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Strauss C, Neu M, Bischoff B, Romstöck J. Clinical and Neurophysiological Observations after Superior Petrosal Vein Obstruction during Surgery of the Cerebellopontine Angle: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200105000-00043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Strauss C, Neu M, Bischoff B, Romstöck J. Clinical and neurophysiological observations after superior petrosal vein obstruction during surgery of the cerebellopontine angle: case report. Neurosurgery 2001; 48:1157-9; discussion 1159-61. [PMID: 11334285 DOI: 10.1097/00006123-200105000-00043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Preservation of venous drainage during surgery of the cerebellopontine angle has received little attention. CLINICAL PRESENTATION We describe changes in brainstem auditory evoked potentials after temporary obstruction of the superior petrosal vein during surgical resection of a small meningioma at the petrous apex via a standard suboccipital-lateral approach. Temporary clipping of the petrosal vein resulted in deterioration of the brainstem auditory evoked potentials. The tumor was removed with preservation of the superior petrosal vein. CONCLUSION A transient postoperative cochlear nerve deficit emphasizes the importance of venous drainage and its preservation during surgery for small lesions of the cerebellopontine angle that do not distort normal anatomic structures.
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Affiliation(s)
- C Strauss
- Department of Neurosurgery, University of Erlangen-Nürnberg, Germany.
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Neu M, Strauss C, Romstöck J, Bischoff B, Fahlbusch R. The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery. Clin Neurophysiol 1999; 110:1935-41. [PMID: 10576490 DOI: 10.1016/s1388-2457(99)00148-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Based on a consecutive series of 70 hearing patients with unilateral acoustic neurinomas and intraoperative monitoring of brain-stem auditory evoked potentials (BAEP), 4 dynamic BAEP patterns could be characterized. These patterns correspond with early and late postoperative hearing outcome. All patients with stable wave V (pattern 1) showed definite hearing preservation, all patients with irreversible abrupt loss of BAEP (pattern 2) lost their hearing, despite early hearing preservation in two cases. All patients with irreversible progressive loss of either wave I or wave V (pattern 3) eventually suffered from definite postoperative hearing loss, despite early hearing preservation in two cases. Those cases with intraoperative reversible loss of BAEP (pattern 4) showed variable short and long term hearing outcome. In 34% hearing was preserved, 44% suffered from postoperative hearing loss, the remaining 22% showed postoperative hearing fluctuation, either as a delayed hearing loss or as reversible hearing loss. Postoperative hearing fluctuation indicates anatomical and functional preservation of the cochlear nerve during surgery and is suggestive of a pathophysiological mechanism initiated during the surgical procedure and continuing thereafter. Patients at risk for delayed hearing loss can be identified during surgery by a characteristic BAEP pattern and may benefit from vasoactive treatment.
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Affiliation(s)
- M Neu
- Department of Neurosurgery, University of Erlangen-Nuremberg, Germany
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Chen TC, Rabb C, Apuzzo ML. Complex Technical Methodologies and Their Applications in the Surgery of Intracranial Meningiomas. Neurosurg Clin N Am 1994. [DOI: 10.1016/s1042-3680(18)30530-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Haid CT, Wigand ME. Advantages of the enlarged middle cranial fossa approach in acoustic neurinoma surgery. A review. Acta Otolaryngol 1992; 112:387-407. [PMID: 1441980 DOI: 10.3109/00016489209137419] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Utilizing an enlarged middle cranial fossa approach to the cerebello-pontine angle without destruction of the labyrinth or cochlea the authors have since 1981 operated on 263 unilateral acoustic neurinomas. Tumour sizes ranged between 3 mm intrameatal and 35 mm within the cerebello-pontine angle. Complete tumour removal was accomplished in 96%. There was one postoperative mortality, and only rarely neurological complications. Excellent function of the facial nerve was obtained in 78% (in small and medium sized neurinomas 90% House I and II) and severe paralysis persisted in only 6%. Preservation of hearing was possible in 70% of the small tumours, and in 50% of the total group. Against this background comparable data of the literature are reviewed, and the indications for the enlarged midfossa approach analyzed.
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Affiliation(s)
- C T Haid
- Department of Oto-Rhino-Laryngology, University of Erlangen-Nuremburg, Germany
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