Cochlear implantation in an intralabyrinthine acoustic neuroma patient after resection of an intracanalicular tumour

AbstractThis case study describes a therapeutic strategy using a cochlear implant for a bilateral acoustic neuroma deafened patient. The cochlear nerve had previously been sacrificed on one side during tumour removal, but on the remaining side a functioning cochlear nerve was assessed by electric promontory stimulation in spite of a neuroma extending into the vestibular labyrinth. The patient was successfully stimulated with a Nucleus 22- channel implant after removal of the intracanalicular portion of the neuroma via a middle fossa approach.

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/jns.2002.97.2.0337 ◽

2002 ◽

Vol 97 (2) ◽

pp. 337-340 ◽

Cited By ~ 46

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.

Download Full-text

Middle Fossa Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

CSurgeries ◽

10.17797/2018061401 ◽

2018 ◽

Author(s):

Cameron Wick ◽

Samuel Barnett ◽

J. Walter Kutz Jr. ◽

Brandon Isaacson

Keyword(s):

Vestibular Schwannoma ◽

Acoustic Neuroma ◽

Middle Fossa ◽

Middle Fossa Approach

Download Full-text

Pearls for the middle fossa approach in acoustic neuroma surgery

Current Opinion in Otolaryngology & Head & Neck Surgery ◽

10.1097/moo.0000000000000479 ◽

2018 ◽

Vol 26 (5) ◽

pp. 276-279

Author(s):

Kevin A. Peng ◽

Gregory P. Lekovic ◽

Eric P. Wilkinson

Keyword(s):

Acoustic Neuroma ◽

Middle Fossa ◽

Middle Fossa Approach ◽

Acoustic Neuroma Surgery

Download Full-text

Evaluating Intracochlear Trauma after Cochlear Implant Electrode Insertion through Middle Fossa Approach in Temporal Bones

Otolaryngology ◽

10.1177/0194599817739837 ◽

2017 ◽

Vol 158 (2) ◽

pp. 350-357 ◽

Cited By ~ 2

Author(s):

Juan Carlos Cisneros Lesser ◽

Rubens de Brito ◽

Graziela de Souza Queiroz Martins ◽

Eloisa Maria Mello Santiago Gebrim ◽

Ricardo Ferreira Bento

Keyword(s):

Cochlear Implant ◽

Round Window ◽

Middle Cranial Fossa ◽

Middle Fossa ◽

Insertion Depth ◽

Middle Fossa Approach ◽

Basal Turn ◽

Fresh Frozen ◽

Electrode Insertion ◽

Temporal Bones

Objective To evaluate cochlear trauma after cochlear implant insertion through a middle fossa approach by means of histologic and imaging studies in temporal bones. Study Design Prospective cadaveric study. Setting University-based temporal bone laboratory. Subjects and Methods Twenty fresh-frozen temporal bones were implanted through a middle cranial fossa basal turn cochleostomy. Ten received a straight electrode and 10 a perimodiolar electrode. Samples were fixed in epoxy resin. Computed tomography (CT) scans determined direction, depth of insertion, and the cochleostomy to round window distance. The samples were polished by a microgrinding technique and microscopically visualized to evaluate intracochlear trauma. Descriptive and analytic statistics were performed to compare both groups. Results The CT scan showed intracochlear insertions in every bone, 10 directed to the middle/apical turn and 10 to the basal turn. In the straight electrode group, the average number of inserted electrodes was 12.3 vs 15.1 for the perimodiolar group ( U = 78, P = .0001). The median insertion depth was larger for the perimodiolar group (14.4 mm vs 12.5 mm, U = 66, P = .021). Only 1 nontraumatic insertion was achieved and 14 samples (70%) had important trauma (Eshraghi grades 3 and 4). No differences were identified comparing position or trauma grades for the 2 electrode models or when comparing trauma depending on the direction of insertion. Conclusion The surgical technique allows a proper intracochlear insertion, but it does not guarantee a correct scala tympani position and carries the risk of important trauma to cochlear microstructures.

Download Full-text

Pitfalls in the management of monaural deafness

The Journal of Laryngology & Otology ◽

10.1017/s0022215111000934 ◽

2011 ◽

Vol 125 (7) ◽

pp. 741-744 ◽

Cited By ~ 2

Author(s):

Y-M Feng ◽

Y-Q Wu ◽

H-Q Zhou ◽

H-B Shi

Keyword(s):

Case Report ◽

Cochlear Implant ◽

Acoustic Neuroma ◽

Cochlear Implantation ◽

The Other ◽

Environmental Sound ◽

Stimulation Level ◽

Sound Discrimination ◽

Severe Tinnitus

AbstractObjective:We report a patient who underwent cochlear implantation in an ear with long-term deafness, after an acoustic neuroma had been removed surgically from the other, hitherto good ear and the cochlear nerve had subsequently been resected to relieve severe tinnitus.Method:Case report.Results:The patient could not tolerate the cochlear implant, because of a moderate headache due to the stimulation level necessary for environmental sound discrimination.Conclusion:Cochlear implantation in patients with long-term deafness should be considered carefully, even if deafness is monaural.

Download Full-text