Nerve origin of vestibular schwannoma: a prospective study

2007 ◽  
Vol 122 (2) ◽  
pp. 128-131 ◽  
Author(s):  
T Khrais ◽  
G Romano ◽  
M Sanna
Keyword(s):  
Vestibular Schwannoma ◽  
Tumour Size ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Vestibular Nerve ◽  
Case Review ◽  
Explanatory Factors ◽  
Inferior Vestibular Nerve ◽  
A Prospective Study

AbstractObjective:The origin of vestibular schwannoma has always been a matter of debate. The aim of our study was to identify the nerve origin of this tumour.Study design:Prospective case review. This study was conducted at Gruppo Otologico, a private referral centre for neurotology and skull base surgery.Methods:A total of 200 cases of vestibular schwannoma were included in the study. All the tumours were removed surgically utilising the translabyrinthine approach. The origin of the tumour was sought at the fundus of the internal auditory canal.Results:A total of 200 consecutive cases was included in the study. The origin of the tumour was limited to one nerve at the fundus in 152 cases (76 per cent). Out of these cases, the tumour originated from the inferior vestibular nerve in 139 cases (91.4 per cent), from the superior vestibular nerve in nine cases (6 per cent), from the cochlear nerve in two cases (1.3 per cent) and from the facial nerve in two cases (1.3 per cent).Conclusion:The vast majority of vestibular schwannomas originate from the inferior vestibular nerve; the incidence of involvement of this nerve increases as the tumour size increases. An origin of vestibular schwannoma from the inferior vestibular nerve can be considered as one of the explanatory factors for the poor functional outcome of the extended middle cranial fossa approach, and probably accounts also for the better hearing preservation rate reported in some series for the retrosigmoid approach.

Tumor origin and hearing preservation in vestibular schwannoma surgery

2011 ◽  
Vol 115 (5) ◽  
pp. 900-905 ◽  
Author(s):  
Jens Rachinger ◽  
Stefan Rampp ◽  
Julian Prell ◽  
Christian Scheller ◽  
Alex Alfieri ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Hearing Preservation ◽  
Vestibular Nerve ◽  
Cochlear Nerve ◽  
Nerve Function ◽  
Nerve Preservation ◽  
Tumor Origin ◽  
Inferior Vestibular Nerve ◽  
Vs Removal

Object Preservation of cochlear nerve function in vestibular schwannoma (VS) removal is usually dependent on tumor size and preoperative hearing status. Tumor origin as an independent factor has not been systematically investigated. Methods A series of 90 patients with VSs, who underwent surgery via a suboccipitolateral route, was evaluated with respect to cochlear nerve function, tumor size, radiological findings, and intraoperatively confirmed tumor origin. All patients were reevaluated 12 months after surgery. Results Despite comparable preoperative cochlear nerve status and larger tumor sizes, hearing preservation was achieved in 42% of patients with tumor originating from the superior vestibular nerve, compared with 16% of those with tumor originating from the inferior vestibular nerve. Conclusions Tumor origin is an important prognostic factor for cochlear nerve preservation in VS surgery.

Hearing Preservation After Translabyrinthine Vestibular Schwannoma Excision: Audiometry and Electrocochleography Results

2018 ◽  
Vol 127 (8) ◽  
pp. 563-567 ◽  
Author(s):  
Kenneth Akakpo ◽  
William J. Riggs ◽  
Michael S. Harris ◽  
Edward E Dodson
Keyword(s):  
Hair Cell ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Cell Activity ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Healthy Patient ◽  
Cochlear Hair Cell ◽  
Translabyrinthine Approach ◽  
Cranial Nerve Viii

Objectives: To describe a case of inadvertent hearing preservation following a classical translabyrinthine resection of a vestibular schwannoma of the internal auditory canal in an otherwise healthy patient. Methods: Herein, we describe the case of an otherwise healthy patient who underwent resection of an intracanalicular vestibular schwannoma via a translabyrinthine approach. Furthermore, as part of an ongoing study aimed at characterizing hearing changes due to intraoperative events, cochlear hair cell and nerve activity were monitored using electrocochleography throughout surgery. Unexpectedly, the patient maintained serviceable hearing following surgery. As a result, we are able to provide electrophysiologic evidence of cochlear hair cell activity at various stages of this surgery. Results: Hair cell responses across tested frequencies were detectable prior to and following completion of the translabyrinthine procedure. Neural integrity of the auditory division of cranial nerve VIII was maintained throughout. Lastly, postoperative audiometric testing supported the patient’s subjective assertion of serviceable hearing in the surgical ear. Conclusion: Our results suggest that some degree of hair cell and neural integrity can be maintained throughout the course of the translabyrinthine approach, and if preservation of the auditory division of cranial nerve VIII is feasible, a functional amount of hearing preservation is attainable.

Sudden deafness in vestibular schwannoma

1994 ◽  
Vol 108 (2) ◽  
pp. 116-119 ◽  
Author(s):  
David A. Moffat ◽  
David M. Baguley ◽  
Hubertus von Blumenthal ◽  
Richard M. Irving ◽  
David G. Hardy
Keyword(s):  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Tumour Size ◽  
Internal Auditory Canal ◽  
Sudden Deafness ◽  
Aetiological Factor ◽  
Caloric Test ◽  
Significant Difference ◽  
Facial Numbness ◽  
The Mean

AbstractTwelve per cent of a series of 284 patients with vestibular schwannoma presented with sudden deafness. If sudden sensorineural hearing loss is present then it is very likely to be the main presenting symptom. The mean length of patients' history is eight months shorter in this group than in the non-sudden deafness group. Sixteen per cent of vestibular schwannoma patients without sudden deafness present with a 'dead' ear whereas 29.5 per cent of those presenting with sudden deafness have total hearing loss. There was no significant difference between the sudden deafness group and the 'all others' group with regard to tumour size, udiogram shape, caloric test, imbalance, and facial numbness. Although the numbers of patients with sudden deafness in this series were too small to reach significance, on the basis of the clinical correlation of vestibular schwannoma morphology it is possible to postulate that compression of the vasculature within the bony internal auditory canal by a laterally arising tumour may be the aetiological factor and may be more likely to occur than in more medially arising tumours.

Modified translabyrinthine approach and hearing preservation: imaging evaluation

2007 ◽  
Vol 121 (8) ◽  
pp. 736-741 ◽  
Author(s):  
G Magliulo ◽  
A Stasolla ◽  
D Parrotto ◽  
M Marini
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Ct Scans ◽  
Successful Outcome ◽  
Imaging Evaluation ◽  
Translabyrinthine Approach ◽  
Hearing Function ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

AbstractAim:To establish if the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of the vestibule, after the removal of vestibular schwannoma by a modified translabyrinthine approach, correlate with a successful outcome, defined as hearing preservation.Materials and methods:Our study group consisted of 16 patients with vestibular schwannoma. All patients' pre-operative hearing was graded as class one or two according to the Gardner–Robertson scale. On MRI scans, the schwannoma, including the intracanalicular segment, were less than 2 cm in size in all the patients. The intracanalicular portion involved the fundus of the internal auditory canal in seven patients. In the remaining nine patients, the schwannoma had spread to involve two-thirds of the meatus, sparing its lateral third. The state of the labyrinth, in particular the integrity of the vestibule, was evaluated by CT scans and MRI prior to and following surgery.Results:The schwannoma was completely removed in all patients. None showed any signs of persistence or tumoral relapse on the post-operative MRI. The final follow up showed that seven patients had maintained their hearing function (i.e. four patients with class one hearing and three with class two). The MRI vestibular signal on the T2-weighted images was well depicted only in patients with hearing preservation. Bony vestibular integrity was observed in the CT scans of all cases with hearing preservation, and also in three cases with failure of hearing preservation.Conclusion:Our results confirm that total isolation and maintenance of an anatomically intact vestibule, as depicted by MRI examination, is one of the fundamental factors for successful preservation of hearing function following modified translabyrinthine approach schwannoma removal.

Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma?

2005 ◽  
Vol 132 (3) ◽  
pp. 459-466 ◽  
Author(s):  
Vittorio Colletti ◽  
Francesco Fiorino
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Selection Criteria ◽  
Surgical Techniques ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Class A ◽  
Longitudinal Investigation

OBJECTIVES: To compare the 2 surgical techniques most commonly used during vestibular schwannoma (VS) surgery, i.e., the middle fossa (MF) and the retrosigmoid-transmeatal (RS-TM) routes, when hearing preservation is attempted. STUDY DESIGN: A longitudinal study of a series of consecutive patients operated on with the 2 techniques by the same surgeon was conducted. Selection criteria included tumor confined to the internal auditory canal (IAC) with a length ranging from 4 to 12 mm and hearing class A or B. Patients were alternately assigned to 1 of the 2 groups regardless of auditory class and distance of the tumor from the IAC fundus. Thirty-five subjects were operated on with the RS-TM technique and 35 via the MF route. RESULTS: No significant differences in auditory and facial nerve function results between the 2 techniques were observed. The RS-TM approach, however, showed better facial nerve results at discharge. VS size, IAC enlargement, and, particularly, the distance from the IAC fundus were found to influence the postoperative results more than the type of approach itself. CONCLUSIONS: The MF approach has been described as being the better technique for VS surgery in terms of auditory results. However, this claim lacks statistical substantiation because no prospective studies are to be found in the literature. The present longitudinal investigation shows that the MF approach does not afford any particular advantages over the RS-TM route in terms of auditory results in intracanalicular VS, with the exception of tumors reaching the IAC fundus.

Modifying the translabyrinthine approach to preserve hearing during acoustic tumour surgery

1991 ◽  
Vol 105 (1) ◽  
pp. 34-37 ◽  
Author(s):  
John T. McElveen ◽  
Robert H. Wilkins ◽  
Andrea C. Erwin ◽  
Robert D. Wolford
Keyword(s):  
Hearing Preservation ◽  
Vestibular Nerve ◽  
Translabyrinthine Approach ◽  
Inferior Vestibular Nerve ◽  
Acoustic Schwannoma ◽  
Acoustic Tumour

AbstractRemoving an acoustic schwannoma using the translabyrinthine approach has previously been considered incompatible with hearing preservation. By modifying the approach and preventing the loss of endolymph, we have successfully removed an intracanalicular acoustic schwannoma, which originated from the inferior vestibular nerve, and preserved hearing in the operated ear. This report represents the preliminary findings using this particular technique in the management of an intracanalicular acoustic tumour.

Left-sided retrosigmoid craniotomy for the resection of a vestibular schwannoma

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Peter S. Amenta ◽  
Jacques J. Morcos
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Patient Positioning ◽  
Standard Technique ◽  
Hearing Preservation ◽  
Surgical Access ◽  
Wide Range ◽  
Primary Means

The cerebellopontine angle is the site for a wide-range of neoplastic and vascular pathologies. The retrosigmoid craniotomy remains the primary means by which to gain surgical access to this anatomically complex region. We present our standard technique for the completion of a retrosigmoid craniotomy and the resection of a left-sided vestibular schwannoma. Anatomy pertinent to the approach, including, the transverse and sigmoid sinuses, cranial nerves, and internal auditory canal (IAC) is displayed. Special emphasis is placed on patient positioning, adequate bone removal, and tumor resection. The drilling of the IAC and tumor dissection from the VII-VIII complex is also highlighted. Hearing preservation was achieved.The video can be found here: http://youtu.be/FFZju5vcBi0.

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