scholarly journals A novel scoring system for vestibular schwannomas to identify candidacy for cochlear implantation

2021 ◽  
Author(s):  
Valerie Dahm ◽  
Ursula Schwarz-Nemec ◽  
Alice Auinger ◽  
Erdem Yildiz ◽  
Christian Matula ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Brain Stem ◽  
Vestibular Schwannoma ◽  
Cochlear Implantation ◽  
Scoring System ◽  
Cochlear Nerve ◽  
Vestibular Schwannomas ◽  
Open Set ◽  
Brain Stem Response ◽  
New Scoring

Objectives Here we present the audiometric outcomes of patients undergoing vestibular schwannoma resection and cochlear implantation. We additionally reviewed preoperative audiometric and radiological data, with the aim of developing a new scoring system to identify suitable patients for this treatment course. Methods After translabyrinthine vestibular schwannoma resection, cochlear nerve conduction was evaluated using intraoperative electrically evoked brain stem response audiometry. Patients with positive results received a cochlear implant. We evaluated the preoperative audiometric results, and vestibular schwannoma size and extension, to develop a new scoring system to identify patients with higher likelihood of nerve integrity after tumor removal and subsequent cochlear implantation. Results Seventeen patients with unilateral sporadic vestibular schwannomas underwent translabyrinthine resection, of whom ten received a cochlear implant. Ten patients are daily cochlear implant users. The mean word recognition score ss 28% at 65 dB, and 52% at 80 dB. Nine of the ten patients have open-set speech understanding. All patients whose vestibular schwannoma did not make contact with the modiolus were able to receive a cochlear implant, compared to none of the patients with modiolus infiltration. Tumor size alone did not predict the probability of sparing the cochlear nerve. Conclusions Simultaneous translabyrinthine vestibular schwannoma excision and cochlear implantation based on intraoperative electrically evoked brain stem response audiometry measurements is a good option for hearing rehabilitation. Preoperative exact assessment of the vestibular schwannoma extension, audiometric testing, and promontory stimulation electrically evoked brain stem response audiometry could improve preoperative patient selection and predict the possibility of cochlear implantation.

The Prognostic Value of Promontory Electric Auditory Brain Stem Response in Pediatric Cochlear Implantation

2000 ◽  
Vol 21 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Thomas P. Nikolopoulos ◽  
Steve M. Mason ◽  
Kevin P. Gibbin ◽  
Gerard M. OʼDonoghue
Keyword(s):  
Brain Stem ◽  
Cochlear Implantation ◽  
Prognostic Value ◽  
Auditory Brain Stem Response ◽  
Auditory Brain Stem ◽  
Brain Stem Response

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

2020 ◽  
Vol 129 (12) ◽  
pp. 1229-1238
Author(s):  
Matthew J. Urban ◽  
Dennis M. Moore ◽  
Keri Kwarta ◽  
John Leonetti ◽  
Rebecca Rajasekhar ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cochlear Implantation ◽  
Neurofibromatosis Type ◽  
Auditory Brainstem ◽  
Observation Time ◽  
Vestibular Schwannomas ◽  
Open Set ◽  
Pubmed Database ◽  
Auditory Brainstem Implants ◽  
Hearing Outcomes

Objectives: Historically, eventual loss of cochlear nerve function has limited patients with neurofibromatosis type 2 (NF2) to auditory brainstem implants (ABI), which in general are less effective than modern cochlear implants (CI). Our objective is to evaluate hearing outcomes following ipsilateral cochlear implantation in patients with NF2 and irradiated vestibular schwannomas (VS), and sporadic VS that have been irradiated or observed. Methods: Multi-center retrospective analysis of ipsilateral cochlear implantation in the presence of observed and irradiated VS. MESH search in NCBI PubMed database between 1992 and 2019 for reported cases of cochlear implantation with unresected vestibular schwannoma. Results: Seven patients underwent ipsilateral cochlear implantation in the presence of observed or irradiated vestibular schwannomas. Four patients had sporadic tumors with severe-profound contralateral hearing loss caused by presbycusis/hereditary sensorineural hearing loss, and three patients with NF2 lost contralateral hearing after prior surgical resection. Prior to implantation, one VS was observed without growth for a period of 7 years and the others were treated with radiotherapy. Mean post-operative sentence score was 63.9% (range 48-91) at an average of 28 (range 2-84) months follow up. All patients in this cohort obtained open set speech perception. While analysis of the literature is limited by heterogenous data reporting, 85% of implants with observed schwannomas achieved some open set perception, and 67% of patients previously radiated schwannomas. Furthermore, blending literature outcomes for post implantation sentence testing in quiet without lip-reading show 59.0 ± 35% for patients with CI and observed tumors and 55.7 ± 35% for patients with radiated tumors, with both groups ranging 0 to 100%. Conclusion: This retrospective series and literature review highlight that hearing outcomes with CI for VS patients are superior to those achieved with ABI. However, important considerations including imaging, delayed hearing loss, and observation time cannot be ignored in this population.

scholarly journals Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a “Test Intracochlear Electrode”

2019 ◽  
Vol 80 (01) ◽  
pp. e1-e9 ◽  
Author(s):  
Anand Kasbekar ◽  
Yu Chuen Tam ◽  
Robert Carlyon ◽  
John Deeks ◽  
Neil Donnelly ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Vestibular Schwannoma ◽  
Intraoperative Monitoring ◽  
Neurofibromatosis Type ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Tertiary Referral Center ◽  
Objective Evidence ◽  
Brainstem Response

Objectives A decision on whether to insert a cochlear implant can be made in neurofibromatosis 2 (NF2) if there is objective evidence of cochlear nerve (CN) function post vestibular schwannoma (VS) excision. We aimed to develop intraoperative CN monitoring to help in this decision. Design We describe the intraoperative monitoring of a patient with NF2 and our stimulating and recording set up. A novel test electrode is used to stimulate the CN electrically. Setting This study was set at a tertiary referral center for skull base pathology. Main outcome measure Preserved auditory brainstem responses leading to cochlear implantation. Results Electrical auditory brainstem response (EABR) waveforms will be displayed from different stages of the operation. A cochlear implant was inserted at the same sitting based on the EABR. Conclusion Electrically evoked CN monitoring can provide objective evidence of CN function after VS excision and aid in the decision-making process of hearing rehabilitation in patients who will be rendered deaf.

Ipsilateral Cochlear Implantation After Cochlear Nerve Preserving Vestibular Schwannoma Surgery in Patients With Neurofibromatosis Type 2

2014 ◽  
Vol 35 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Simon Kingsley Wickham Lloyd ◽  
Fergal John Glynn ◽  
Scott Alexander Rutherford ◽  
Andrew Thomas King ◽  
Deborah Jane Mawman ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Implantation ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Cochlear Nerve

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

1996 ◽  
Vol 110 (6) ◽  
pp. 570-573 ◽  
Author(s):  
Tetsuya Tono ◽  
Yasuaki Ushisako ◽  
Tamotsu Morimitsu
Keyword(s):  
Cochlear Implant ◽  
Acoustic Neuroma ◽  
Cochlear Implantation ◽  
Therapeutic Strategy ◽  
Cochlear Nerve ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Tumour Removal ◽  
Bilateral Acoustic Neuroma

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.

Auditory Brain Stem Response Predictors of Hearing Outcomes after Middle Fossa Resection of Vestibular Schwannomas

2021 ◽  
Author(s):  
Yin Ren ◽  
Catherine M. Merna ◽  
Kareem O. Tawfik ◽  
Marc S. Schwartz ◽  
Rick A. Friedman
Keyword(s):  
Brain Stem ◽  
Tumor Resection ◽  
Vestibular Schwannomas ◽  
Characteristic Analysis ◽  
Level Of Evidence ◽  
Auditory Brain Stem Response ◽  
Response Predictors ◽  
Auditory Brain Stem ◽  
Hearing Outcomes ◽  
Brain Stem Response

Abstract Objectives To analyze the relationship between preoperative and intraoperative auditory brain stem response (ABR) characteristics and hearing outcomes in patients with vestibular schwannomas (VS) undergoing hearing preservation (HP) surgery via a middle cranial fossa (MCF) approach. Design Prospective study. Setting Academic tertiary skull base referral center. Methods Pre- and postoperative pure-tone average (PTA) and word recognition score (WRS) were examined. Intraoperative ABR wave III latency, wave V latency, and amplitude were recorded. HP was defined as postoperative WRS ≥50%. Participants Adult patients with VS and WRS ≥50% who underwent MCF tumor resection between November 2017 and September 2019. Main Outcome Measures Postoperative hearing outcomes. Results Sixty patients were included. Mean tumor size was 9.2 mm (range, 3–17). HP rates were 56.7% for the cohort and 69.7% for tumors <10 mm. A complete loss of wave V was associated with an 82.9% increase in postoperative PTA (p < 0.001) and 97.2% decrease in WRS (p < 0.001), whereas a diminished wave V was correlated with 62.7% increase in PTA (p < 0.001) and 55.7% decrease in WRS (p = 0.006). A diminished or absent wave V, but not increased wave III/V latency or decreased wave V amplitude, was correlated with a decline in postoperative hearing class (r = 0.735, p < 0.001). Receiver-operating characteristic analysis demonstrated that a stable wave V has the highest accuracy in predicting HP (sensitivity of 82.6%, specificity of 84.8%). Conclusion Of the examined preoperative and intraoperative ABR characteristics, a stable wave V intraoperatively was the strongest predictor of HP after MCF resection of VS. Level of Evidence Level III.

scholarly journals Translabyrinthine resection of NF2 associated vestibular schwannoma with cochlear implant insertion

2021 ◽  
Vol 5 (2) ◽  
pp. V14
Author(s):  
Cathal John Hannan ◽  
Priya Sharma ◽  
Matthew Edward Smith ◽  
Laurence Johann Glancz ◽  
Martin O’Driscoll ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Vestibular Schwannoma ◽  
Neurofibromatosis Type ◽  
Cochlear Nerve ◽  
Csf Leak ◽  
Tumor Control ◽  
Nerve Preservation ◽  
A Minor ◽  
Facial Function

The authors present the case of a 24-year-old female with neurofibromatosis type 2. Growth of the left vestibular schwannoma and progressive hearing loss prompted the decision to proceed to translabyrinthine resection with cochlear nerve preservation and cochlear implant insertion. Complete resection with preservation of the facial and cochlear nerves was achieved. The patient had grade 1 facial function and was discharged on postoperative day 4 following suturing of a minor CSF leak. This case highlights the feasibility of cochlear nerve preservation and cochlear implant insertion in appropriately selected patients, offering a combination of effective tumor control and hearing rehabilitation. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21122

scholarly journals A novel scoring system for vestibular schwannomas to identify candidacy for cochlear implantation

2021 ◽  
Author(s):  
Christoph Arnoldner ◽  
Ursula Schwarz-Nemec ◽  
Alice Auinger ◽  
Erdem Yildiz ◽  
Christian Matula ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Scoring System ◽  
Vestibular Schwannomas
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