scholarly journals Hydroxyapatite cement cranioplasty in the setting of simultaneous translabyrinthine resection of cerebellopontine angle tumors and cochlear implantation

2021 ◽  
Vol 5 (2) ◽  
pp. V15
Author(s):  
Robert M. Conway ◽  
Nathan C. Tu ◽  
Pedrom C. Sioshansi ◽  
Dennis I. Bojrab ◽  
Jeffrey T. Jacob ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Cochlear Implantation ◽  
Cerebellopontine Angle ◽  
Similar Efficacy ◽  
Abdominal Fat ◽  
Vestibular Schwannomas ◽  
Fat Graft ◽  
Surgical Video ◽  
Hydroxyapatite Cement

Cochlear implantation (CI) has become an option for the treatment of hearing loss after translabyrinthine resection of vestibular schwannomas. The surgical video presents the case of a 67-year-old male who had translabyrinthine resection of vestibular schwannoma with simultaneous CI and closure with a hydroxyapatite (HA) cement cranioplasty. HA cement cranioplasty can be utilized in place of abdominal fat graft for the closure of translabyrinthine approaches with similar efficacy and complication profile. To the authors’ knowledge, this is the first reported case of a simultaneous CI and translabyrinthine resection of vestibular schwannoma with HA cement cranioplasty. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID211

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

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 Cerebellopontine angle meningiomas: postoperative outcomes in a modern cohort

2013 ◽  
Vol 35 (6) ◽  
pp. E10 ◽  
Author(s):  
Vijay Agarwal ◽  
Ranjith Babu ◽  
Jordan Grier ◽  
Owoicho Adogwa ◽  
Adam Back ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Medical Records ◽  
Cerebellopontine Angle ◽  
Jugular Foramen ◽  
Vestibular Schwannomas ◽  
Categorical Variables ◽  
Tumor Type ◽  
Tumor Extension ◽  
Duration Of Symptoms ◽  
Internal Acoustic Canal

Object Tumors of the cerebellopontine angle (CPA) have always proven difficult for neurosurgeons to optimally manage. Studies investigating the natural history and treatment of vestibular schwannomas have dominated the literature in this regard. Distinguishing meningiomas from schwannomas in this location carries particular importance as each tumor type has certain prognostic and surgical considerations. In this study, the authors have characterized the outcomes of 34 patients surgically treated for CPA meningiomas and have investigated various factors that may affect postoperative neurological function. Methods The medical records of patients with CPA meningiomas who underwent surgery from 2005 to 2013 at the Duke University Health System were reviewed. Various patient, clinical, and tumor data were gathered from the medical records including patient demographics, pre- and postoperative neurological examinations, duration of symptoms, procedural details, tumor pathology and size, and treatment characteristics. Differences in continuous variables were then analyzed using the Student t-test while categorical variables were evaluated using the chi-square test. Results A total of 34 patients underwent surgical treatment for CPA meningiomas during the 8-year period. Jugular foramen invasion was seen in 17.6% of tumors, with nearly half (41.2%) extending into the internal acoustic canal. The most common presenting symptom was hearing loss (58.8%), followed by headache (52.9%) and facial numbness/pain (50.0%). The most common cranial nerve (CN) affected was CN X (11.8%), followed by CNs VI and VII (5.9%). Postoperatively, no patients experienced a decrease in hearing, with only 5.9% of patients experiencing facial nerve palsies. Patients with tumors larger than 3 cm had a significantly higher incidence of permanent CN deficits than those with smaller tumors (45.5% vs 5.9%, respectively; p = 0.011). Also, tumor extension into the jugular foramen was associated with the occurrence of lower CN deficits, none of which occurred in tumors without jugular foramen invasion. Internal acoustic canal tumor extension was not seen to be associated with postoperative complications or CN deficits. Conclusions Meningiomas of the CPA are challenging lesions to treat surgically. However, the risk of facial palsy and hearing loss is significantly lower when compared with vestibular schwannomas. Novel methods for preoperative differentiation are needed to appropriately counsel patients on surgical risks. Also, due to the significant potential for neurological deficits, further studies are needed to investigate the utility of radiotherapy for these lesions.

S241 – Acoustic Neuroma Surgery: Hydroxyapatite Cement Cranioplasty

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P156-P156 ◽  
Author(s):  
Emma A. Kruger ◽  
Moises A Arriaga ◽  
Douglas Chen ◽  
Todd Hillman
Keyword(s):  
Acoustic Neuroma ◽  
Bone Substitute ◽  
Abdominal Fat ◽  
Fat Graft ◽  
Csf Leak ◽  
Wound Complications ◽  
Reconstruction Technique ◽  
Lumbar Drain ◽  
Acoustic Neuroma Surgery ◽  
Hydroxyapatite Cement

Objectives To review the outcome of hydroxyapatite cement cranioplasy in acoustic neuroma surgery using trans-labyrinthine and retrosigmoid approaches. Methods Retrospective chart review of the cases of acoustic neuroma resection performed in our institution from January 1, 2007, until November 1, 2007, using 2 separate types of hydroxyapatite cranioplasty in wound closure. Abdominal fat graft in case of translabyrinthine approach and either abdominal fat graft or duragen were covered using Hydrset (Stryker) or Bonesouce (Stryker) hydroxyapatitie cement bone substitute. Translabyrinthine and Retrosigmoid resections were included in the review. The rate of postoperative cerebrospinal fluid leak, lumbar drain use, and early wound complications were recorded. Results There were 33 cases of acoustic neuroma resection over a period of 10 months using hydroxyapatite cranioplasty. Hydroset bone substitue was used in 16 cases and no CSF leak was observed. Bonesource bone substitute was used in 17 cases and 1 case of CSF leak was observed. The leak was managed with lumbar drain placement and resolved without any additional interventions. In the Hydroset group no drains were used, and in the Bonsource group drains were placed at the completeion of a procedure and removed 12 hours postoperatively. There were no wound complications seen at the completeion of the review. No other adverse outcomes were noted. Conclusions Both forms of hydroxyapatite cranioplasty are reliable methods to avoid CSF leak in acoustic neuroma surgery. The handling characteristics and no need for drain with Hydroset may make it preferable as a bone reconstruction technique in acoustic neuroma surgery.

Transapical extension in difficult cerebellopontine angle tumours: preliminary report

2003 ◽  
Vol 117 (10) ◽  
pp. 788-792 ◽  
Author(s):  
Mario Sanna ◽  
Manoj Agarwal ◽  
Yogesh Jain ◽  
Alessandra Russo ◽  
Abdel Kader Taibah
Keyword(s):  
Vestibular Schwannoma ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Vestibular Schwannomas ◽  
Type I ◽  
Posterior Surface ◽  
Prepontine Cistern ◽  
Anterior Extension

Difficult cerebellopontine angle (CPA) tumours namely large/giant vestibular schwannomas, vestibular schwannomas with a significant anterior extension and meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal (IAC) have always posed a problem for the otoneurosurgeon. Modifications of the enlarged translabyrinthine approach (ETLA) specifically aimed at dealing with these tumours are not reported. The aim of this paper is to introduce the transapical extension of ETLA which involves increased circumferential drilling around the IAC beyond 270°C. The extension allows enhanced surgical control over the tumour as well as the anterior aspect of the CPA including the prepontine cistern, the Vth and VIth cranial nerves. The extension is further classified into Type I and II depending upon the extent of drilling. Type I extension entails drilling around the IAC for 300–320° and is indicated for large/giant vestibular schwannomas (large vestibular schwannoma extrameatal diameter 3–3.9 cm, giant vestibular schwannoma extrameatal diameter [ges ]4 cm) and vestibular schwannomas with significant anterior extension. Type II extension involves complete drilling around the canal for 360° and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the IAC.

Glossopharyngeal schwannoma in childhood

2008 ◽  
Vol 2 (2) ◽  
pp. 130-132 ◽  
Author(s):  
J. Alex Thomas ◽  
William O. Bank ◽  
John S. Myseros
Keyword(s):  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Glossopharyngeal Nerve ◽  
Unilateral Hearing Loss ◽  
Cerebellopontine Angle Tumor ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Radiographic Presentation

Glossopharyngeal (that is, cranial nerve IX) schwannomas are extremely rare nerve sheath tumors that frequently mimic the more common vestibular schwannoma in their clinical as well as radiographic presentation. Although rare in adults, this tumor has not been reported in a child. The authors report the case of a 10-year-old boy who presented with several months of unilateral hearing loss. He was found to have a large right cerebellopontine angle tumor. Given the boy's primary complaint of hearing loss and the appearance of the lesion on imaging, the tumor was initially believed to be a schwannoma of the vestibular nerve. It was found intraoperatively, however, to originate from the glossopharyngeal nerve. To the authors' knowledge, this is the first reported case of a glossopharyngeal schwannoma in a child.

The use of magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss

2021 ◽  
pp. 1-4
Author(s):  
C Saxby ◽  
F Koumpa ◽  
S Mohamed ◽  
A Singh
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Vestibular Schwannoma ◽  
Case Series ◽  
Vestibular Schwannomas ◽  
Pulsatile Tinnitus ◽  
Internal Auditory Meatus ◽  
Resonance Imaging ◽  
Imaging Evaluation

Abstract Background Tinnitus is a common condition presenting to the ENT out-patient clinic. Vestibular schwannomas are benign cerebellopontine angle tumours that usually present with unilateral sensorineural hearing loss. Magnetic resonance imaging of the internal auditory meatus is the definitive investigation in their detection. The current recommendation is for unilateral tinnitus patients to undergo magnetic resonance imaging of the internal auditory meatus to exclude vestibular schwannoma. Objective To evaluate magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Method A retrospective case series was conducted of all patients who underwent magnetic resonance imaging of the internal auditory meatus to investigate unilateral non-pulsatile tinnitus without asymmetrical hearing loss, from 1 January 2014 to 1 January 2019. Results Of 2066 scans, 566 (27 per cent) were performed to investigate patients (335 female, 231 male) with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Three vestibular schwannomas were detected on imaging, and 134 incidental findings were discovered. Conclusion The detection rate of vestibular schwannoma in this group was just 0.3 per cent. This paper questions the utility of magnetic resonance imaging evaluation in these patients.

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.

scholarly journals The use of Hydroxyapatite Cement and a Pericranial/Deep Temporal Fascia Graft for Cranioplastic Reconstruction of Translabyrinthine Craniectomy Defects

2005 ◽  
Vol 84 (2) ◽  
pp. 86-92 ◽  
Author(s):  
Akhtar Hussain ◽  
Farhan Ahsan
Keyword(s):  
Donor Site ◽  
Abdominal Fat ◽  
Fat Graft ◽  
Great Promise ◽  
Temporal Fascia ◽  
Fascia Graft ◽  
A New Technique ◽  
Considerable Morbidity ◽  
Hydroxyapatite Cement ◽  
Csf Leaks

Most translabyrinthine temporal bone defects are reconstructed with free abdominal fat grafts, with or without the use of hydroxyapatite cement. However, these procedures are associated with considerable morbidity at the graft donor site, with a 6 to 15% incidence of cerebrospinal fluid (CSF) leaks, and with postoperative headaches. We have developed a new technique for reconstructive cranioplasty that involves the use of hydroxyapatite cement and a pericranial/deep temporal fascia graft. This technique obviates the need for an abdominal fat graft and therefore circumvents the morbidity associated with it; it may also significantly reduce the incidence of CSF leaks and postoperative headaches. We describe the results of our use of this technique in a series of 10 patients. Based on our early findings, we believe that this technique holds great promise for reconstructive cranioplasty following translabyrinthine craniectomy.

scholarly journals Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness

2021 ◽  
Vol 20 (4) ◽  
pp. 119-125
Author(s):  
Sung Il Nam
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Schwann Cells ◽  
Vestibular Schwannoma ◽  
Cerebellopontine Angle ◽  
Benign Neoplasms ◽  
Eighth Cranial Nerve ◽  
Negative Effect ◽  
Vestibular Symptoms

Vestibular schwannoma (VS) is commonly encountered in the cerebellopontine angle and benign neoplasms that arise from Schwann cells of the eighth cranial nerve, which can show not only hearing loss but also various vestibular symptoms. Dizziness is the symptom causing significantly negative effect on quality of life in patients with VS. Here, we will review the dizziness in VS.

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