Intraoperative Cochlear Nerve Monitoring in Vestibular Schwannoma Surgery – Does It Really Affect Hearing Outcome?

2007 ◽  
Vol 13 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Enrico Piccirillo ◽  
Harukazu Hiraumi ◽  
Masashi Hamada ◽  
Alessandra Russo ◽  
Alessandro De Stefano ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring ◽  
Hearing Outcome

Developing Intraoperative Cochlear Nerve Monitoring during Vestibular Schwannoma Surgery

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Kasbekar ◽  
Y. Tam ◽  
R. Carlyon ◽  
J. Deeks ◽  
N. Donnelly ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring

Length of Tumor-Cochlear Nerve Contact and Hearing Outcome after Surgery for Vestibular Schwannoma

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
Raymund Yong ◽  
Brian Westerberg ◽  
Ryojo Akagami
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Hearing Outcome

Length of tumor–cochlear nerve contact and hearing outcome after surgery for vestibular schwannoma

2008 ◽  
Vol 108 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Raymund L. Yong ◽  
Brian D. Westerberg ◽  
Charles Dong ◽  
Ryojo Akagami
Keyword(s):  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Univariate Analysis ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Magnetic Resonance Images ◽  
Auditory Evoked Potential ◽  
Cochlear Nerve ◽  
Hearing Outcome ◽  
Interpeak Latency

Object Tumor size is likely to be a major determinant of hearing preservation after surgery for vestibular schwannoma. Findings in some large case series have not supported this concept, possibly due to variation in the technique used for tumor measurement. The authors sought to determine if the length of tumor–cochlear nerve contact was predictive of hearing outcome in adults undergoing resection of a vestibular schwannoma. Methods Patients who underwent a hearing-preserving approach for resection of a vestibular schwannoma at one institution by a neurosurgeon/neurotologist team between 2001 and 2005 were screened. Patients with American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Class A or B hearing preoperatively were included. Magnetic resonance images were reviewed and used to calculate the length of tumor–cochlear nerve contact. Tumors were also measured according to AAO-HNS guidelines. Results Thirty-one patients were included, 8 (26%) of whom had hearing preservation. Univariate analysis revealed that extracanalicular length of tumor–cochlear nerve contact (p = 0.0365), preoperative hearing class (p = 0.028), I–V interpeak latency of the brainstem auditory evoked potential (p = 0.021), and the interaural I–V interpeak latency difference (p = 0.018) were predictive of hearing outcome. Multivariate analysis confirmed the predictive value of extra-canalicular length of contact and preoperative hearing class (p = 0.041 and p = 0.0235, respectively). Conclusions Vestibular schwannomas with greater lengths of tumor–cochlear nerve contact increase a patient's risk for hearing loss after surgery with attempted hearing preservation. Involvement of the internal auditory canal produces a constant risk of hearing loss. Data from the experience of a single surgical team can be used to estimate the probability of good hearing outcome for any given patient with serviceable hearing and a vestibular schwannoma.

Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series

2021 ◽  
Author(s):  
Margaret J Butler ◽  
Cameron C Wick ◽  
Matthew A Shew ◽  
Michael R Chicoine ◽  
Amanda J Ortmann ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Implantation ◽  
Case Series ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Cochlear Nerve ◽  
Tumor Removal ◽  
Nerve Monitoring ◽  
Brainstem Response

Abstract BACKGROUND Neurofibromatosis type 2 (NF2) often results in profound hearing loss and cochlear implantation is an emerging hearing rehabilitation option. However, cochlear implant (CI) outcomes in this population vary, and intraoperative monitoring to predict cochlear nerve viability and subsequent outcomes is not well-established. OBJECTIVE To review the use of intraoperative electrically evoked cochlear nerve monitoring in patients with NF2 simultaneous translabyrinthine (TL) vestibular schwannoma (VS) resection and cochlear implantation. METHODS A retrospective review was performed of 3 patients with NF2 that underwent simultaneous TL VS resection and cochlear implantation with electrical auditory brainstem response (eABR) measured throughout tumor resection. Patient demographics, preoperative assessments, surgical procedures, and outcomes were reviewed. RESULTS Patients 1 and 3 had a reliable eABR throughout tumor removal. Patient 2 had eABR pretumor removal, but post-tumor removal eABR presence could not be reliably determined because of electrical artifact interference. All patients achieved auditory percepts upon CI activation. Patients 1 and 2 experienced a decline in CI performance after 1 yr and after 3 mo, respectively. Patient 3 continues to perform well at 9 mo. Patients 2 and 3 are daily users of their CI. CONCLUSION Cochlear implantation is attainable in cases of NF2-associated VS resection. Intraoperative eABR may facilitate cochlear nerve preservation during tumor removal, though more data and long-term outcomes are needed to refine eABR methodology and predictive value for 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.

Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis

2010 ◽  
Vol 124 (5) ◽  
pp. 490-494 ◽  
Author(s):  
S-E Stangerup ◽  
M Tos ◽  
J Thomsen ◽  
P Caye-Thomasen
Keyword(s):  
Vestibular Schwannoma ◽  
Predictive Value ◽  
High Frequency ◽  
Pure Tone ◽  
Hearing Level ◽  
Speech Discrimination ◽  
Resonance Imaging ◽  
Hearing Outcome ◽  
Hearing Outcomes ◽  
Better Than

AbstractAims:This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma.Subjects:Over a 33-year period, 1144 patients with vestibular schwannoma were allocated to ‘wait and scan’ management, with annual magnetic resonance imaging and audiological examination. Two complete pure tone and speech discrimination audiograms were available for 932 patients.Results:The predictive value of initial hearing level better than 10 dB for forecasting hearing outcome after observation increased from 59 per cent at 250 Hz to 94 percent at 4000 Hz. At diagnosis, hearing level of 10 dB or better at 4000 Hz was found in only 18 of the 932 VS ears, while good speech discrimination was found in 159 patients (17 per cent). Of the latter patients, 138 maintained good hearing after observation.Conclusion:In vestibular schwannoma patients, good high frequency hearing and good speech discrimination at diagnosis are useful tools in predicting good hearing after observation.

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/)

Our Experience With Facial Nerve Monitoring in Vestibular Schwannoma Surgery Under Partial Neuromuscular Blockade

2015 ◽  
Vol 66 (4) ◽  
pp. 192-198
Author(s):  
Jorge Vega-Céliz ◽  
Emili Amilibia-Cabeza ◽  
José Prades-Martí ◽  
Nuria Miró-Castillo ◽  
Marta Pérez-Grau ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Neuromuscular Blockade ◽  
Vestibular Schwannoma ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Partial Neuromuscular Blockade
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