scholarly journals Vestibular Nerve Atrophy After Vestibular Neuritis – Results from a Prospective High-Resolution MRI Study

2020 ◽  
Vol 192 (09) ◽  
pp. 854-861 ◽  
Author(s):  
Wolfgang Freund ◽  
Frank Weber ◽  
Daniel Schneider ◽  
Ulrich Mayer ◽  
Marc Scheithauer ◽  
...  
Keyword(s):  
High Resolution ◽  
Internal Auditory Canal ◽  
Vestibular Nerve ◽  
Vestibular Neuritis ◽  
Single Subject ◽  
Symptom Duration ◽  
Cross Sectional ◽  
Canal Paresis ◽  
Inferior Vestibular Nerve ◽  
Mri Study

Purpose Sudden unilateral peripheral vestibular deficit is mostly termed vestibular neuritis (VN), even if its cause or the exact location of the lesion remains unclear. Thus, therapy is mostly symptomatic. We aimed to prove if there is peripheral atrophy after VN with persistent canal paresis. Methods After approval by the ethics committee and according to the declaration of Helsinki and with informed consent, ten patients with persistent canal paresis after VN and ten age-matched healthy controls were included. High-resolution measurement (in-plane resolution 0.2 mm) of the internal auditory canal (IAC) using a 3 D CISS sequence at 3 Tesla was performed. The course of the pertaining nerves was reconstructed in the 3 D dataset and the measurement was performed at 60 % of the length of the IAC. The cross-sectional areas of the superior (SVN) and inferior vestibular nerve (IVN) were taken independently by two blinded readers. Results The interrater difference regarding the area was 22 %. We found significant atrophy of the SVN with a 24 % smaller area (p = 0.026) and found a smaller ratio of SVN/IVN on the symptomatic side (p = 0.017). Concerning single subject data, only 5 patients showed extensive atrophy of the NVS, while 5 patients did not. The time since symptom onset did not significantly influence the atrophy. Conclusion MRI measuring of the area of the NVS after VN could detect atrophy after VN. However, only 5 patients exhibited marked atrophy, while the other 5 patients did not. With the background of stringent inclusion criteria (more than 6 months of symptom duration and proven persistent canal paresis), one has to wonder if there might be different etiologies behind the apparently identical symptoms. Key Points:  Citation Format

Cross-Sectional Vestibular Nerve Analysis in Vestibular Neuritis

2012 ◽  
Vol 121 (7) ◽  
pp. 466-470 ◽  
Author(s):  
Christopher E. Fundakowski ◽  
Joshua Anderson ◽  
Simon Angeli
Keyword(s):  
Vestibular Nerve ◽  
Vestibular Neuritis ◽  
Cross Sectional

scholarly journals Endoscope-assisted middle fossa craniotomy for resection of inferior vestibular nerve schwannoma extending lateral to transverse crest

2018 ◽  
Vol 44 (3) ◽  
pp. E7 ◽  
Author(s):  
Adam N. Master ◽  
Daniel S. Roberts ◽  
Eric P. Wilkinson ◽  
William H. Slattery ◽  
Gregory P. Lekovic
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Senior Author ◽  
Vestibular Nerve ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Speech Discrimination ◽  
Middle Fossa ◽  
Total Resection ◽  
Inferior Vestibular Nerve

OBJECTIVEThe authors describe their results using an endoscope as an adjunct to microsurgical resection of inferior vestibular schwannomas (VSs) with extension into the fundus of the internal auditory canal below the transverse crest.METHODSAll patients who had undergone middle fossa craniotomy for VSs performed by the senior author between September 2014 and August 2016 were prospectively enrolled in accordance with IRB policies, and the charts of patients undergoing surgery for inferior vestibular nerve tumors, as determined either on preoperative imaging or as intraoperative findings, were retrospectively reviewed. Age prior to surgery, side of surgery, tumor size, preoperative and postoperative pure-tone average, and speech discrimination scores were recorded. The presence of early and late facial paralysis, nerve of tumor origin, and extent of resection were also recorded.RESULTSSix patients (all women; age range 40–65 years, mean age 57 years) met these criteria during the study period. Five of the 6 patients underwent gross-total resection; 1 patient underwent a near-total resection because of a small amount of tumor that adhered to the facial nerve. Gross-total resection was facilitated using the operative endoscope in 2 patients (33%) who were found to have additional tumor visible only through the endoscope. All patients had a House-Brackmann facial nerve grade of II or better in the immediate postoperative period. Serviceable hearing (American Academy of Otolaryngology–Head and Neck Surgery class A or B) was preserved in 3 of the 6 patients.CONCLUSIONSEndoscope-assisted middle fossa craniotomy for resection of inferior vestibular nerve schwannomas with extension beyond the transverse crest is safe, and hearing preservation is feasible.

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.

The Unrecognized Rotation of the Vestibular and Cochlear Nerves from the Labyrinth to the Brain Stem: Its Implications to Surgery of the Eighth Cranial Nerve

1986 ◽  
Vol 95 (5) ◽  
pp. 543-549 ◽  
Author(s):  
Herbert Silverstein ◽  
Horace Norrell ◽  
Thomas Haberkamp ◽  
Alan B. Mcdaniel
Keyword(s):  
Brain Stem ◽  
Cleavage Plane ◽  
Internal Auditory Canal ◽  
Vestibular Nerve ◽  
Cochlear Nerve ◽  
Eighth Cranial Nerve ◽  
Vestibular Neurectomy ◽  
Intimate Association ◽  
Inferior Vestibular Nerve ◽  
The Brain

The cochlear and vestibular nerves rotate 90 degrees from the inner ear to the brain stem. Most of the rotation occurs within the internal auditory canal (IAC); only minimal rotation occurs in the cerebellopontine (CP) angle. At the labyrinthine end of the IAC, the cochlear nerve—which at first lies anterior to the inferior vestibular nerve (saccular nerve)—rapidly fuses with the inferior vestibular nerve. It then rotates to become inferior as the nerves leave the porus acousticus. The cochleovestibular (C-V) cleavage plane lies in a superior-inferior direction in the lateral IAC and rotates to become anterior-posterior in the CP angle. In 25% of patients in whom no C-V cleavage plane can be seen, it is not possible to completely transect all vestibular fibers. The surgical implications are that (1) the most complete vestibular neurectomy can be done only in the lateral IAC, (2) the cochlear and inferior vestibular nerves, because of their intimate association, should not be separated in the mid-IAC, in order to prevent damage to the cochlear nerve, and (3) to create a complete denervation of the vestibular labyrinth, only the posterior ampullary nerve along with the superior vestibular nerve should be transected.

scholarly journals Differential Involvement during Latent Herpes Simplex Virus 1 Infection of the Superior and Inferior Divisions of the Vestibular Ganglia: Implications for Vestibular Neuritis

2017 ◽  
Vol 91 (14) ◽  
Author(s):  
Susanne Himmelein ◽  
Anja Lindemann ◽  
Inga Sinicina ◽  
Anja K. E. Horn ◽  
Thomas Brandt ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Vestibular Nerve ◽  
Vestibular Neuritis ◽  
Herpes Simplex Virus 1 ◽  
Superior Part ◽  
New Information ◽  
Inferior Vestibular Nerve ◽  
Simplex Virus ◽  
Hsv 1

ABSTRACT Controversy still surrounds both the etiology and pathophysiology of vestibular neuritis (VN). Especially uncertain is why the superior vestibular nerve (SVN) is more frequently affected than the inferior vestibular nerve (IVN), which is partially or totally spared. To address this question, we developed an improved method for preparing human vestibular ganglia (VG) and nerve. Subsequently, macro- and microanatomical as well as PCR studies were performed on 38 human ganglia from 38 individuals. The SVN was 2.4 mm longer than the IVN, and in 65% of the cases, the IVN ran in two separate bony canals, which was not the case for the SVN. Anastomoses between the facial and cochlear nerves were more common for the SVN (14/38 and 9/38, respectively) than for the IVN (7/38 and 2/38, respectively). Using reverse transcription-quantitative PCR (RT-qPCR), we found only a few latently herpes simplex virus 1 (HSV-1)-infected VG (18.4%). In cases of two separate neuronal fields, infected neurons were located in the superior part only. In summary, these PCR and micro- and macroanatomical studies provide possible explanations for the high frequency of SVN infection in vestibular neuritis. IMPORTANCE Vestibular neuritis is known to affect the superior part of the vestibular nerve more frequently than the inferior part. The reason for this clinical phenomenon remains unclear. Anatomical differences may play a role, or if latent HSV-1 infection is assumed, the etiology may be due to the different distribution of the infection. To shed further light on this subject, we conducted different macro- and microanatomical studies. We also assessed the presence of HSV-1 in VG and in different sections of the VG. Our findings add new information on the macro- and microanatomy of the VG as well as the pathophysiology of vestibular neuritis. We also show that latent HSV-1 infection of VG neurons is less frequent than previously reported.

Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery

2003 ◽  
Vol 117 (2) ◽  
pp. 104-108 ◽  
Author(s):  
Kentaro Ochi ◽  
Toru Ohashi ◽  
Shoji Watanabe
Keyword(s):  
Time Course ◽  
Vestibular Nerve ◽  
Vestibular Neuritis ◽  
Nerve Function ◽  
Vestibular Evoked Myogenic Potential ◽  
Caloric Testing ◽  
Myogenic Potential ◽  
Inferior Vestibular Nerve

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

Relationship between Signal Intensity of the Labyrinth and Cochleovestibular Testing and Morphologic Features of Vestibular Schwannoma

2021 ◽  
Author(s):  
Felipe Constanzo ◽  
Bernardo Corrêa de Almeida Teixeira ◽  
Patricia Sens ◽  
Dante Escuissato ◽  
Ricardo Ramina
Keyword(s):  
Vestibular Schwannoma ◽  
Signal Intensity ◽  
Internal Auditory Canal ◽  
Vestibular Nerve ◽  
Head Impulse Test ◽  
Speech Discrimination ◽  
Unaffected Side ◽  
Cross Sectional ◽  
Tertiary Referral Center ◽  
Cystic Tumors

Abstract Objectives The aim of this article was to evaluate the relationship between signal intensity of the labyrinth and vestibulocochlear function and morphologic features of vestibular schwannoma (VS). Design Cross-sectional Study. Setting Tertiary referral center. Participants Fifty-four patients with sporadic, untreated VS. Main Outcome Measure Signal intensity of the cochlea and vestibule (SIRc and SIRv: signal intensity of cochlea/vestibule compared with cerebellar signal intensity; AURc and AURv: SIRc/SIRv of the affected side compared with the unaffected side) in 1.5T T2-weighted images was correlated with size (Hannover classification), cystic status, distance from the fundus of the internal auditory canal, video head impulse test (vHIT), and audiometry. Results Signal intensity of the vestibule was higher than that of the cochlea (p < 0.01). Large tumors had lower SIRc than smaller tumors (p = 0.03); Hannover T1 tumors had higher SIRc (p < 0.01), SIRv (p < 0.01), AURc (p < 0.01) and AURv (p < 0.01) than the rest; heterogenous and cystic tumors had higher SIRv than solid large tumors (p = 0.02); superior vestibular nerve pattern on vHIT had higher SIRv and AURv than inferior vestibular nerve and mixed patterns (p = 0.03 and 0.004, respectively); and there was a weak correlation between AURv and speech discrimination (r = 0.33, p = 0.04). Conclusion A more abnormal signal intensity of the labyrinth is associated with larger size and solid status of VS. There was a positive relationship between signal intensity of the labyrinth and speech discrimination scores on audiogram.

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