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.

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.

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.

scholarly journals Diamond knife dissection technique for nerve preservation during resection of large vestibular schwannomas

2021 ◽  
Vol 5 (2) ◽  
pp. V8
Author(s):  
Julia Shawarba ◽  
Cand Med ◽  
Matthias Tomschik ◽  
Karl Roessler
Keyword(s):  
Vestibular Schwannoma ◽  
Facial Nerve Palsy ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Dissection Techniques ◽  
Dissection Technique ◽  
Large Vestibular Schwannoma ◽  
Facial Function ◽  
Diamond Knife

Facial and cochlear nerve preservation in large vestibular schwannomas is a major challenge. Bimanual pincers or plate-knife dissection techniques have been described as crucial for nerve preservation. The authors demonstrate a recently applied diamond knife dissection technique to peel the nerves from the tumor capsule. This technique minimizes the nerve trauma significantly, and complete resection of a large vestibular schwannoma without any facial nerve palsy and hearing preservation is possible. The authors illustrate this technique during surgery of a 2.6-cm vestibular schwannoma in a 27-year-old male patient resulting in normal facial function and preserved hearing postoperatively. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21104

Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

2007 ◽  
Vol 117 (12) ◽  
pp. 2087-2092 ◽  
Author(s):  
Abraham Jacob ◽  
Lawrence L. Robinson ◽  
Jared S. Bortman ◽  
Lianbo Yu ◽  
Edward E. Dodson ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Tertiary Care ◽  
Hearing Preservation ◽  
Academic Center ◽  
Nerve Of Origin

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/)

Preservation of tap vestibular evoked myogenic potentials despite resection of the inferior vestibular nerve

2004 ◽  
Vol 14 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Krister Brantberg ◽  
Tiit Mathiesen
Keyword(s):  
Bone Conduction ◽  
Vestibular Function ◽  
Vestibular Nerve ◽  
Vestibular Evoked Myogenic Potentials ◽  
Nerve Function ◽  
Sound Stimulation ◽  
Vestibular Loss ◽  
Vestibular Neurectomy ◽  
Inferior Vestibular Nerve ◽  
Healthy Side

Sound and skull-tap induced vestibular evoked myogenic potentials (VEMP) were studied in a 43-year-old man following inferior vestibular neurectomy. Surgery was performed because of a small acoustic neuroma. Postoperative caloric testing suggested sparing of superior vestibular nerve function on the operated side. In response to sound stimulation there were no VEMP on the operated side, irrespective of whether sounds were presented by air- or bone-conduction. This suggests sound-induced VEMP to be critically dependent on inferior vestibular nerve function and this is in agreement with present knowledge. However, VEMP were obtained in response to forehead skull taps, i.e. positive-negative VEMP not only on the healthy side but also on the operated side. This suggests remnant vestibular function on the operated side of importance for forehead skull tap VEMP, because with complete unilateral vestibular loss there are no (positive-negative) VEMP on the lesioned side. Thus, forehead skull-tap VEMP depend, at least partly, on the superior vestibular nerve function.

The Influence of Prophylactic Vasoactive Treatment on Cochlear and Facial Nerve Functions after Vestibular Schwannoma Surgery

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Christian Scheller ◽  
Hans-Peter Richter ◽  
Martin Engelhardt ◽  
Ralph Köenig ◽  
Gregor Antoniadis
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Function ◽  
Open Label ◽  
Exact Test ◽  
Number Of Patients ◽  
Facial Nerves ◽  
Prophylactic Use ◽  
Long Term Observation

Abstract OBJECTIVE Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experiments with facial nerves of the rat and retrospectively analyzed clinical studies showed a beneficial effect of vasoactive treatment on the preservation of facial and cochlear nerve functions. This prospective and open-label randomized pilot study is the first study of a prophylactic vasoactive treatment in vestibular schwannoma surgery. METHODS Thirty patients were randomized before surgery. One group (n = 14) received a vasoactive prophylaxis consisting of nimodipine and hydroxyethylstarch which was started the day before surgery and was continued until the seventh postoperative day. The other group (n = 16) did not receive preoperative medication. Intraoperative monitoring, including acoustic evoked potentials and continuous facial electromyelograms, was applied to all patients. However, when electrophysiological signs of a deterioration of facial or cochlear nerve function were detected in the group of patients without medication, vasoactive treatment was started immediately. Cochlear and facial nerve function were documented preoperatively, during the first 7 days postoperatively, and again after long-term observation. RESULTS Despite the limited number of patients, our results were significant using the Fisher's exact test (small no. of patients) for a better outcome after vestibular schwannoma surgery for both hearing (P = 0.041) and facial nerve (P = 0.045) preservation in the group of patients who received a prophylactic vasoactive treatment. CONCLUSION Prophylactic vasoactive treatment consisting of nimodipine and hydroxyethylstarch shows significantly better results concerning preservation of the facial and cochlear nerve function in vestibular schwannoma surgery. The prophylactic use is also superior to intraoperative vasoactive treatment.

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