Two very small intracanalicular tumors, resected en bloc with the complete eighth nerve, were serially sectioned in order to study the relationship between the tumors and the nerves of origin. Both cases met the size criteria for hearing conservation surgery; however, the patient with the smaller tumor and the better hearing had no recognizable cochlear nerve fibers passing the tumor. The cochlear nerve in the patient with poorer hearing was completely free of tumor. The tumor with the infiltrated cochlear nerve seemed to originate from the inferior vestibular nerve. The other tumor seemed to arise from the superior vestibular nerve. Proximally, the tumors occupied a more central location in the involved nerves, but they abruptly became eccentric and exophytic as they proceeded laterally. Nerve fibers remaining about the tumors were displaced to the periphery. These nerve fiber aggregates became quite thin and attenuated, frequently separating into smaller aggregates which, ultimately, were incorporated into the tumors. As fibers came closer to the tumors, they tended to change from their longitudinal direction toward a more circumferential orientation about the surface of the tumors. The tumor-nerve fiber interfaces were quite variable throughout the course of the tumor, ranging from large aggregates of nerve fibers distinctly separate from the tumors to aggregates separate but tightly applied to the tumors without a tissue plane between, to aggregates partially incorporated within the periphery of the tumors, to aggregates completely incorporated into the periphery of the tumors. Frequently several types of interfaces were seen in the same section. These findings showed that in one case the cochlear nerve could have been surgically separated from the acoustic tumor; in the other specimen, it could not have been separated. It was impossible to predict between the two. In these two very small tumors, the gross specimen observation correlated reasonably well with the histology, thus suggesting that intraoperative observation may be a predictor in hearing conservation surgery; however, previous studies in slightly larger tumors make this an extremely guarded concept.
Anomalies of Response Patterns of Single Cochlear Nerve Fibers to Click Stimuli
