scholarly journals Does Attempt at Hearing Preservation Microsurgery of Vestibular Schwannoma Affect Postoperative Tinnitus?

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Martin Chovanec ◽  
Eduard Zvěřina ◽  
Oliver Profant ◽  
Zuzana Balogová ◽  
Jan Kluh ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Hearing Level ◽  
Eighth Cranial Nerve ◽  
A Prospective Study ◽  
Tumor Consistency ◽  
Neurovascular Structures ◽  
New Onset

Background. The aim of this study was to analyze the effect of vestibular schwannoma microsurgery via the retrosigmoid-transmeatal approach with special reference to the postoperative tinnitus outcome.Material and Methods. A prospective study was performed in 89 consecutive patients with unilateral vestibular schwannoma indicated for microsurgery. Patient and tumor related parameters, pre- and postoperative hearing level, intraoperative findings, and hearing and tinnitus handicap inventory scores were analyzed.Results. Cochlear nerve integrity was achieved in 44% corresponding to preservation of preoperatively serviceable hearing in 47% and useful hearing in 21%. Main prognostic factors of hearing preservation were grade/size of tumor, preoperative hearing level, intraoperative neuromonitoring, tumor consistency, and adhesion to neurovascular structures. Microsurgery led to elimination of tinnitus in 66% but also new-onset of the symptom in 14% of cases. Preservation of useful hearing and neurectomy of the eighth cranial nerve were main prognostic factors of tinnitus elimination. Preservation of cochlear nerve but loss of preoperative hearing emerged as the main factor for tinnitus persistence and new onset tinnitus. Decrease of THI scores was observed postoperatively.Conclusions. Our results underscore the importance of proper pre- and intraoperative decision making about attempt at hearing preservation versus potential for tinnitus elimination/risk of new onset of tinnitus.

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/)

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 surgery in vestibular schwannoma

2006 ◽  
Vol 120 (5) ◽  
pp. 366-370 ◽  
Author(s):  
Tarek Khrais ◽  
Mario Sanna
Keyword(s):  
Vestibular Schwannoma ◽  
Tumour Size ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Hearing Level ◽  
Review Of Literature ◽  
Tertiary Referral Centre ◽  
Class A ◽  
Strong Inverse Relationship ◽  
Hearing Preservation Surgery

Objectives: To study the effect of pre-operative hearing level and tumour size on the hearing outcome of hearing preservation surgery for vestibular schwannoma.Study design and setting: A review of literature conducted at Gruppo Otologico, a tertiary referral centre for neurotology and skull base surgery.Results: A total of 1993 patients in 16 publications addressing the topic of hearing preservation surgery in vestibular schwannoma were analysed. The American Academy of Otolaryngology–Head and Neck Surgery hearing classification system was the classification upon which we based our analysis.Conclusion: Defining hearing preservation as class-A hearing, there was a strong inverse relationship between pre-operative hearing and post-operative hearing levels and between tumour size and post-operative hearing levels.

scholarly journals Clinical Evaluation of CyberKnife in the Treatment of Vestibular Schwannomas

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Jo-Ting Tsai ◽  
Jia-Wei Lin ◽  
Chien-Min Lin ◽  
Yuan-Hao Chen ◽  
Hsin-I Ma ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Prognostic Factors ◽  
Clinical Evaluation ◽  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Hearing Preservation ◽  
Tumor Control ◽  
Auditory Function ◽  
Tumor Control Rate ◽  
Preservation Rate

Objective. This study assessed the posttreatment tumor control and auditory function of vestibular schwannoma (VS) patients after CyberKnife (CK) and analyzed the possible prognostic factors of hearing loss.Methods. We retrospectively studied 117 VS patients, with Gardner-Robertson (GR) classification grades I to IV, who underwent CK between 2006 and 2012. Data including radiosurgery treatment parameters, pre- and postoperative tumor size, and auditory function were collected and examined.Results. With CK, 117 patients had excellent tumor control rates (99.1%), with a mean imaging followup of 61.1 months. Excluding 52 patients (GR III-IV pretreatment), 53 (81.5%) of the remaining 65 patients (initial GR I-II) maintained GR I or II hearing after CK, with a mean audiometric followup of 64.5 months. Twelve patients experienced hearing degradation (91.6% were GR II pretreatment); they appeared to have significantly larger tumor sizes, significantly smaller cochlear sizes, and higher prescribed cochlear doses, compared to the patients with preserved hearing.Conclusion. Our data showed that CK treatment provided an excellent tumor control rate and a comparable hearing preservation rate in VS patients. Patients with pretreatment GR II hearing levels, larger tumor volumes, smaller cochlear sizes, and higher prescribed cochlear doses may have poor hearing prognoses.

Preservation of hearing after surgery for acoustic schwannomas: correlation between cochlear nerve function and operative findings

1994 ◽  
Vol 80 (5) ◽  
pp. 844-848 ◽  
Author(s):  
Hiromichi Umezu ◽  
Tadashi Aiba
Keyword(s):  
Tumor Size ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Hearing Level ◽  
Tumor Removal ◽  
Content Type ◽  
Acoustic Schwannoma ◽  
Operative Findings ◽  
Total Tumor Removal ◽  
Results Of Surgery

✓ The results of surgery in 66 patients with acoustic schwannoma in whom total tumor removal was accomplished are reviewed in terms of the relationships among tumor size, preoperative hearing level, operative findings (including the shape and location of the cochlear nerve at the tumor surface), and the extent of post-operative hearing preservation. Both tumor size and the preoperative hearing level were correlated with the shape of the cochlear nerve, which more frequently formed a solid bundle when the tumor was small or the preoperative hearing was excellent. Hearing was retained postoperatively only in cases in which the nerve formed a solid bundle and could be differentiated and separated from the tumor capsule without difficulty. These findings suggest that tumor size and preoperative hearing level, which have been reported to be the main prognostic factors of postoperative hearing preservation, may influence the results of surgery for acoustic schwannoma through the shape of the cochlear nerve.

Hearing Preservation after Acoustic Neuroma Surgery with Intraoperative Direct Eighth Cranial Nerve Monitoring: Part II. A Classification of Results

1986 ◽  
Vol 95 (3_part_1) ◽  
pp. 285-291 ◽  
Author(s):  
Herbert Silverstein ◽  
Alan Mcdaniel ◽  
Horace Norrell
Keyword(s):  
Intraoperative Monitoring ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Class Iii ◽  
Tumor Removal ◽  
Eighth Cranial Nerve ◽  
Nerve Monitoring ◽  
Eighth Nerve ◽  
Auditory Evoked Response ◽  
Acoustic Neuromas

Since the advent of brainstem auditory evoked response audiometry and computerized tomography, small acoustic neuromas are more frequently found. Often the patient has serviceable hearing, which we would like to preserve during complete tumor removal. Since 1978, sixteen patients with acoustic neuromas have been operated upon through the retrosigmoid suboccipital approach, with the goal of hearing preservation. In 1983, we began using intraoperative direct eighth nerve monitoring, which produced a rapid assessment of cochlear nerve function during the excision of small acoustic neuromas. The tumors varied in size from intracanalicular lesions to one lesion with a 3.0 cm protrusion medial to the porus acousticus. In eight of sixteen cases, intraoperative monitoring was used, and in four of the patients hearing was preserved. In eight cases, intraoperative monitoring was not used, and hearing was preserved in only two patients. The overall success rate—in total tumor removal with hearing preservation—was 37%. Hearing was preserved in six of eight patients who had tumors which measured less than 1.5 cm. In this group of cases, two of the patients had a Class I good hearing result (PTA 0 to 30 dB and 70 to 100% discrimination), one patient had Class III nonserviceable hearing, (PTA 65 to 75 dB and 25 to 45% discrimination), and three patients had Class IV poor hearing, (PTA 80 to 100 dB and 0 to 20% discrimination). We found that continuous monitoring of direct eighth-nerve-evoked action potentials were extremely valuable and rapidly indicated reversible cochlear nerve trauma.

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 Retrosigmoid Approach for Vestibular Schwannoma

2018 ◽  
Vol 80 (S 03) ◽  
pp. S271-S271
Author(s):  
Mohammed Aref ◽  
Katherine Kunigelis ◽  
Stephen P. Cass ◽  
A. Samy Youssef
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Cochlear Nerve ◽  
Management Options ◽  
Suppurative Otitis Media ◽  
History Of ◽  
The Right

Vestibular schwannoma is a benign tumor that affects 3% of the population, but accounts for 85% of tumors occurring at the cerebellopontine angle (CPA). In this case, we present a 48-year-old female with history of cholesteatoma on the right and chronic suppurative otitis media on the left who presented with an 18 month history of bilateral hearing loss, worse on the right. Investigations revealed a right sided vestibular schwannoma measuring 1.6 cm in diameter. Audiogram revealed an AAO–HNS (American Academy of Otolaryngology–Head and Neck Surgery) class C hearing on the right and class B on the left. There are several management options for this size of vestibular schwannoma including observation and radiosurgery. However, preserving cochlear nerve function remains a challenging enterprise. Furthermore, the ideal management that confers the highest chance of hearing preservation remains heavily debated. Given the patient's young age, the goal of hearing preservation and the tumor size/extension into the CPA, surgery was decided through a right retrosigmoid transmeatal approach for tumor resection with intraoperative brain auditory evoked responses monitoring. For hearing preservation, we emphasize few important dissection techniques: tumor debulking from the top first to avoid early manipulation of the cochlear nerve at the bottom of the tumor, sharp dissection from medial to lateral off the vestibular nerve which is kept intact as a tension band to minimize cochlear nerve manipulations, and limit the drilling of the posterolateral wall of the internal auditory canal (IAC) medial to the labyrinth and endolymphatic apparatus. Postoperatively, the patient was discharged home within 2 days, with imaging showing a gross total resection. Follow-up audiogram shows unchanged pure tone thresholds.The link to the Video can be found at: https://youtu.be/Z5ftkpJN5k8.

Efficacy of Corticosteroids in Hearing Preservation after Radiosurgery for Vestibular Schwannoma: A Prospective Study

2011 ◽  
Vol 89 (1) ◽  
pp. 25-33 ◽  
Author(s):  
Jin Wook Kim ◽  
Dong Gyu Kim ◽  
Sun Ha Paek ◽  
Hyun-Tai Chung ◽  
Yong Hwy Kim ◽  
...  
Keyword(s):  
Prospective Study ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
A Prospective Study

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.

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