Hearing conservation in acoustic neuroma surgery via the posterior fossa

1990 ◽  
Vol 104 (6) ◽  
pp. 463-467 ◽  
Author(s):  
D. L. Baldwin ◽  
T. T. King ◽  
A. W. Morrisin
Keyword(s):  
Posterior Fossa ◽  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Surgical Removal ◽  
Speech Discrimination ◽  
Hearing Conservation ◽  
Operative Morbidity ◽  
Number Of Patients ◽  
Principle Objective

AbstractAn increasing number of patients with an acoustic neuroma present with useful hearing in the tumour ear. Surgical removal of these tumours via the posterior fossa route may enable preservation of the cochlear nerve and otic capsule without increasing the morbidity to the facial nerve. The results of treating 51 cases of acoustic neuroma via the posterior fossa is presented. Forty four tumours measured less than 20 mm in diameter in the cerebellopontine angle and surgery was undertaken with hearing preservation as a principle objective. In 26 cases, the cochlear nerve was preserved anatomically and post-operative hearing at levels better than mean pure tone threshold of 50 dB or 50 per cent speech discrimination was recorded in 14 patients. The preservation of hearing represents a worthwhile surgical goal in selected patients with an acoustic neuroma without increasing the operative morbidity.

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor

2002 ◽  
Vol 97 (2) ◽  
pp. 337-340 ◽  
Author(s):  
Takuzou Moriyama ◽  
Takanori Fukushima ◽  
Katsuyuki Asaoka ◽  
Pierre-Hugues Roche ◽  
David M. Barrs ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Significant Prognostic Factor ◽  
Speech Discrimination ◽  
Middle Fossa ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Fine Print

Object. To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. Methods. Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average ≤ 50 dB and speech discrimination score ≥ 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. Conclusions. The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.

Preservation of hearing in patients undergoing excision of acoustic neuromas and other cerebellopontine angle tumors

1985 ◽  
Vol 63 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Charles H. Tator ◽  
Julian M. Nedzelski
Keyword(s):  
Tumor Size ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Consecutive Series ◽  
Speech Discrimination ◽  
Content Type ◽  
Acoustic Neuromas ◽  
Fine Print

✓ Microsurgical techniques have made it possible to identify and preserve the cochlear nerve from its origin at the brain stem and along its course through the internal auditory canal in patients undergoing removal of small or medium-sized acoustic neuromas or other cerebellopontine angle (CPA) tumors. In a consecutive series of 100 patients with such tumors operated on between 1975 and 1981, an attempt was made to preserve the cochlear nerve in 23. The decision to attempt to preserve hearing was based on tumor size and the degree of associated hearing loss. In cases of unilateral acoustic neuroma, the criteria for attempted preservation of hearing were tumor size (2.5 cm or less), speech reception threshold (50 dB or less), and speech discrimination score (60% or greater). In patients with bilateral acoustic neuromas or tumors of other types, the size and hearing criteria were significantly broadened. All patients were operated on through a suboccipital approach. Hearing was preserved postoperatively in six (31.6%) of the 19 patients with unilateral acoustic neuromas, although the cochlear nerve was preserved in 16. Of the six patients with postoperative hearing, three retained excellent hearing, and the other three had only sound awareness and poor discrimination. Hearing was preserved in three cases with other CPA tumors, including an epidermoid cyst and small petrous meningiomas in the internal auditory canal. Of the two cases with bilateral tumors, hearing was preserved in one. Of the 23 patients in whom hearing preservation was attempted, nine (39.1%) had some postoperative hearing, which in six was equal to or better than the preoperative level. Thus, it is worthwhile to attempt hearing preservation in selected patients with CPA tumors.

Stability of hearing preservation and regeneration capacity of the cochlear nerve following vestibular schwannoma surgery via a retrosigmoid approach

2016 ◽  
Vol 125 (5) ◽  
pp. 1277-1282 ◽  
Author(s):  
Christian Scheller ◽  
Andreas Wienke ◽  
Marcos Tatagiba ◽  
Alireza Gharabaghi ◽  
Kristofer F. Ramina ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Strong Association ◽  
Pure Tone Audiometry ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Speech Discrimination ◽  
Regeneration Capacity ◽  
Postoperative Course ◽  
Link Type ◽  
Hearing Abilities

OBJECTIVE The purpose of this research was to examine the stability of long-term hearing preservation and the regeneration capacity of the cochlear nerve following vestibular schwannoma (VS) surgery in a prospective study. METHODS A total of 112 patients were recruited for a randomized multicenter trial between January 2010 and April 2012 to investigate the efficacy of prophylactic nimodipine treatment versus no prophylactic nimodipine treatment in VS surgery. For the present investigation, both groups were pooled to compare hearing abilities in the early postoperative course and 1 year after the surgery. Hearing was examined using pure-tone audiometry with speech discrimination, which was performed preoperatively, in the early postoperative course, and 12 months after surgery and was subsequently classified by an independent otorhinolaryngologist using the Gardner-Robertson classification system. RESULTS Hearing abilities at 2 time points were compared by evaluation in the early postoperative course and 1 year after surgery in 102 patients. The chi-square test showed a very strong association between the 2 measurements in all 102 patients (p < 0.001) and in the subgroup of 66 patients with a preserved cochlear nerve (p < 0.001). CONCLUSIONS There is no significant change in cochlear nerve function between the early postoperative course and 1 year after VS surgery. The result of hearing performance, as evaluated by early postoperative audiometry after VS surgery, seems to be a reliable prognosticator for future hearing ability. Clinical trial registration nos.: 2009-012088-32 (clinicaltrialsregister.eu) and DRKS 00000328 (“AkNiPro,” drks-neu.uniklinik-freiburg.de/drks_web/)

Hearing preservation in acoustic neuroma surgery: Value of monitoring cochlear nerve action potentials

1994 ◽  
Vol 111 (6) ◽  
pp. 703-709 ◽  
Author(s):  
J NEDZELSKI ◽  
C CHIONG ◽  
M CASHMAN ◽  
S STANTON ◽  
D ROWED
Keyword(s):  
Acoustic Neuroma ◽  
Action Potentials ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Nerve Action ◽  
Acoustic Neuroma Surgery

Transient facial nerve palsy after topical papaverine application during vestibular schwannoma surgery

2007 ◽  
Vol 107 (5) ◽  
pp. 1039-1042 ◽  
Author(s):  
James K. Liu ◽  
Christina M. Sayama ◽  
Clough Shelton ◽  
Joel D. MacDonald
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Conduction Block ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Speech Discrimination ◽  
The Right

✓Some evidence in the literature supports the topical application of papaverine to the cochlear nerve to prevent internal auditory artery vasospasm and cochlear ischemia as a method of enhancing the ability to preserve hearing during acoustic neuroma surgery. The authors report a case of transient facial nerve palsy that occurred after papaverine was topically applied during a hearing preservation acoustic neuroma removal. A 58-year-old woman presented with tinnitus and serviceable sensorineural hearing loss in her right ear (speech reception threshold 15 dB, speech discrimination score 100%). Magnetic resonance imaging demonstrated a 1.5-cm acoustic neuroma in the right cerebellopontine angle (CPA). A retrosigmoid approach was performed to achieve gross-total resection of the tumor. During tumor removal, a solution of 3% papaverine soaked in a Gelfoam pledget was placed over the cochlear nerve. Shortly thereafter, the quality of the facial nerve stimulation deteriorated markedly. Electrical stimulation of the facial nerve did not elicit a response at the level of the brainstem but was observed to elicit a robust response more peripherally. There were no changes in auditory brainstem responses. Immediately after surgery, the patient had a House–Brackmann Grade V facial palsy on the right side. After several hours, this improved to a Grade I. At the 1-month follow-up examination, the patient exhibited normal facial nerve function and stable hearing. Intracisternal papaverine may cause a transient facial nerve palsy by producing a temporary conduction block of the facial nerve. This adverse effect should be recognized when topical papaverine is used during CPA surgery.

scholarly journals Cochlear Nerve Monitoring During Cerebellopontine Angle Operations

1988 ◽  
Vol 15 (1) ◽  
pp. 68-72 ◽  
Author(s):  
D.W. Rowed ◽  
J.M. Nedzelski ◽  
M.Z. Cashman ◽  
S. Stanton ◽  
R.V. Harrison
Keyword(s):  
Acoustic Neuroma ◽  
Action Potentials ◽  
Intraoperative Monitoring ◽  
Cerebellopontine Angle ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Nerve Function ◽  
Vestibular Neurectomy ◽  
Nerve Monitoring ◽  
Small Arteries

ABSTRACT:The authors present their experience with intraoperative monitoring of cochlear nerve action potentials (AP) in 30 adult patients. Operative procedures were acoustic neuroma excision with attempted hearing preservation and selective vestibular neurectomy in patients with incapacitating Meniere's disease and serviceable hearing (SRT<50 db, discrimination >60%). Loss of AP is detected rapidly and has been demonstrated after manipulation of the cochlear nerve and after coagulation of small arteries on the tumour capsule. Presence of an AP at the end of the procedure usually correlates with postoperative preservation of hearing. AP monitoring appears to be a reliable means of detecting potentially reversible changes in cochlear nerve function intraoperatively.

scholarly journals Prophylactic nimodipine treatment for hearing preservation after vestibular schwannoma surgery: study protocol of a randomized multi-center phase III trial—AkniPro 2

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Christian Scheller ◽  
Christian Strauss ◽  
Sandra Leisz ◽  
Pia Hänel ◽  
Ariane Klemm ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Standard Of Care ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Phase Iii ◽  
Control Group ◽  
Nerve Function ◽  
Speech Discrimination ◽  
Phase Iii Trial ◽  
Patient Reported

Abstract Background A previously performed phase III trial on 112 subjects investigating prophylactic nimodipine treatment in vestibular schwannoma (VS) surgery showed no clear beneficial effects on preservation of facial and cochlear nerve functions, though it should be considered that protection of facial nerve function was the primary outcome. However, the risk for postoperative hearing loss was halved in the nimodipine group compared to the control group (OR 0.49; 95% CI 0.18–1.30; p = 0.15). Accordingly, this phase III extension trial investigates the efficacy and safety of prophylactic nimodipine for hearing preservation in VS surgery. Methods This is a randomized, multi-center, two-armed, open-label phase III trial with blinded expert review and two-stage with interim analysis. Three hundred thirty-six adults with the indication for microsurgical removal of VS (Koos I–IV) and serviceable preoperative hearing (Gardner-Robertson scale (GR) 1–3) are assigned to either the therapy (intravenous nimodipine 1–2 mg/h from the day before surgery until the fifth postoperative day and standard of care) or the control group (surgery only and standard of care). The primary endpoint of the trial is postoperative cochlear nerve function measured before discharge according to GR 1–3 versus GR 4–5 (binary). Hearing function will be determined by pre- and postoperative audiometry with speech discrimination, which will be evaluated by a blinded expert reviewer. Furthermore, patient-reported outcomes using standardized questionnaires will be analyzed. Discussion Prophylactic parenteral nimodipine treatment may have a positive effect on hearing preservation in VS surgery and would improve patient’s quality of life. Further secondary analyses are planned. Except for dose-depending hypotension, nimodipine is known as a safe drug. In the future, prophylactic nimodipine treatment may be recommended as a routine medication in VS surgery. VS can be considered as an ideal model for clinical evaluation of neuroprotection, since hearing outcome can be classified by well-recognized criteria. The beneficial effect of nimodipine may be transferable to other surgical procedures with nerves at risk and may have impact on basic research. Trial registration EudraCT 2019-002317-19, DRKS00019107. 8th May 2020.

Hearing Improvement after Conservative Approach for Large Posterior Fossa Meningioma

1993 ◽  
Vol 109 (6) ◽  
pp. 1025-1029 ◽  
Author(s):  
Joel A. Goedel ◽  
Dennis G. Vollmer
Keyword(s):  
Posterior Fossa ◽  
Tumor Size ◽  
Hearing Preservation ◽  
Posterior Fossa Surgery ◽  
Speech Discrimination ◽  
Hearing Improvement ◽  
Mri Scan ◽  
Remarkable Recovery ◽  
Posterior Fossa Meningioma ◽  
Complete Tumor

Hearing preservation during the posterior fossa surgery depends on many factors, including tumor size and site of origin. In many cases, regardless of the presumed tumor origin, the severity of the pure-tone loss or decline in speech discrimination on preoperative testing prompts the surgeon to choose a surgical approach (translabyrinthine or transcochlear) that negates the chance for postoperative functional hearing in the involved ear. We describe a 41-year-old woman with unilateral severe sensorineural hearing loss who experienced a remarkable recovery of hearing after combined retrolabyrinthine and retrosigmoid removal of a 4 cm petrous ridge meningioma using intraoperative cochlear monitoring. Despite the tumor size, early intraoperative loss of wave I and proximity of the tumor to the porus, complete tumor removal was accomplished with preservation of the cochleovestibular bundle. Three weeks postoperatively, the patient noted marked subjective improvement and speech audiometry demonstrated an improvement in word recognition, from 0% to 86%. This improvement has remained 1 year postoperatively, with no evidence of persistent tumor on repeat MRI scan. The case report illustrates the possibility of not just hearing preservation but improvement after removal of even large posterior fossa meningiomas that do not directly invade the cochlear nerve itself.

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