Cochlear implant in vestibular schwannomas: long-term outcomes and critical analysis of indications

Sorrentino, Flavia; Tealdo, Giulia; Cazzador, Diego; Favaretto, Niccolò; Brotto, Davide; Montino, Silvia; Caserta, Ezio; Bovo, Roberto; Denaro, Luca; Baro, Valentina; D’Avella, Domenico; Martini, Alessandro; Mazzoni, Antonio; Marioni, Gino; Zanoletti, Elisabetta

doi:10.1007/s00405-021-07243-0

Cited by 17 publications

(20 citation statements)

References 30 publications

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“…Debate on treatment of small sporadic VS seems destined to continue as the lack of correct clinical studies and the inconclusive observational studies make it difficult to provide the patient with high-level evidence regarding the best clinical outcome with observation or active strategies (30). The opportunity to combine TLAB surgery with a cochlear implant has been recently investigated by several authors (31–34), and might become a factor in favor of proactive surgery . Other surgical approaches as retrosigmoid (2) and middle cranial fossa (35) are in principle hearing-sparing approaches and need to be considered as alternatives to TLAB when there are chances for hearing preservation (2).…”

Section: Discussionmentioning

confidence: 99%

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

et al. 2022

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Objective: Reappraisal of the role of translabyrinthine (TLAB) surgery in small-and medium-sized vestibular schwannomas (VSs). Study Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 330 consecutive patients diagnosed between 1973 and 2019 with small-and medium-sized VS up to 20 mm in the extrameatal portion submitted to surgical treatment. Interventions: VS removal through microscopic TLAB approach. Main Outcome Measures: Facial nerve function according to the House-Brackmann scale at 12-month follow-up, postoperative complications and entity of tumor resection assessed with postoperative MRI. A comparative analysis of outcomes between two groups of patients was further conducted, according to tumor size: Group A, small-sized (intrameatal or ≤10 mm extrameatal tumors) and Group B, medium-sized VSs (extrameatal between 11 and 20 mm). Results: Complete tumor removal was achieved in all cases. The overall complication rate was 5.5%, being cerebrospinal fluid leak the most frequent. Patients with small-sized VS (n = 121) presented a significantly better facial nerve function than patients with medium-sized tumors (n = 209), showing House-Brackmann Grades I to II in 92.6% versus 73.6% of cases, respectively ( p < 0.001). A nearly 4.5-fold higher risk of poor facial nerve function at 12 months affects patients with medium-sized tumors (odds ratio, 4.473; 95% confidence interval, 2.122-9.430; p < 0.001). Conclusion:In the current scenario of multioptional VS management, when hearing preservation is not feasible, early TLAB approach as first-line treatment for small-sized VSs showed favorable results. Factors supporting such proactive surgical treatment include long-term definitive cure, no major complications, good facial nerve outcomes, and the possibility of simultaneous hearing rehabilitation with a cochlear implant.

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Section: Discussionmentioning

confidence: 99%

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

et al. 2022

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“…Based on experience, there have been cases where the cochlear nerve is unequivocally anatomically preserved after VS resection, but the patient does not receive successful stimulation. This suggests that factors such as less severe mechanical trauma (e.g., stretch), thermal injury from cautery, or vascular injury may affect the ability for the cochlear nerve to successfully conduct electrical signal (17,18). Other factors that may also play a role in some cases include cochlear fibrosis/ossification or cochlear nucleus (brainstem) trauma.…”

Section: Discussionmentioning

confidence: 99%

Cochlear Implant Outcomes between Patients with Sporadic and Neurofibromatosis Type 2–Associated Vestibular Schwannoma

et al. 2023

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Objective Compare cochlear implant (CI) performance between patients with ipsilateral sporadic vestibular schwannoma (VS) and NF2-related schwannomatosis (NF2). Compare CI performance according to VS management modality. Study Design Historical cohort. Setting Tertiary academic center. Patients Forty-nine patients (52 ears) undergoing cochlear implantation in the setting of ipsilateral sporadic (n = 21) or NF2-associated VS (n = 28). Interventions CI ipsilateral to VS. Main Outcome Measures Auditory thresholds, consonant–nucleus–consonant (CNC) word scores, and AzBio sentences in quiet scores. Results Among all patients, median post-CI pure tone average was 28 dB HL (interquartile range [IQR], 21–38), CNC word score was 39% (IQR, 6–62), and AzBio sentences in quiet score was 60% (IQR, 11–83) at a median of 12.5 months postimplantation. Despite the NF2 cohort having larger tumors, when comparing patients with sporadic versus NF2-associated VS, there were no statistically significant differences in CNC word (49% [30–70] vs. 31% [0–52]) or AzBio sentences in quiet (66% [28–80] vs. 57% [5–83]) scores. Regardless of NF2 status, all patients managed with observation, and radiosurgery achieved open-set speech. In patients who underwent microsurgery, 6 (46%) of 13 with NF2 achieved open-set speech recognition compared with 4 (67%) of 6 with sporadic disease. Conclusion Select patients with VS achieve successful hearing rehabilitation with a CI. In this cohort, tumor management strategy significantly influenced CI performance, whereas differences in NF2 status exhibited less effect. Specifically, all patients managed with observation or radiosurgery achieved open-set speech perception, whereas approximately half of people with NF2-related VS and two-thirds of people with sporadic VS achieved this outcome after tumor microsurgery. When disease permits, observation and radiosurgery should be considered in patients who may later pursue a CI.

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“…In the other cases of small tumours, when HPS is deemed to have an unsuccessful outcome, observation remains the choice and, if growth is assessed, a prompt shift to TL surgery is recommended. Cochlear implant (CI) rehabilitation is considered in the case of preserved cochlear nerve 25 in early TL and failed HPS cases, whereas hearing aid rehabilitation can be an option in preserved-hearing cases. In clinical practice, when should surgery be performed for a small tumour?…”

Section: Discussionmentioning

confidence: 99%

Early surgery and definitive cure in small sporadic vestibular schwannoma

Zanoletti¹,

Concheri²,

Tealdo³

et al. 2022

Acta Otorhinolaryngol Ital

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Objective. To report surgical outcomes of a cohort of small sporadic vestibular schwannoma and discuss the role of early surgery. Methods. Retrospective descriptive analysis of 234 consecutive patients with small vestibular schwannoma operated on with translabyrinthine or hearing preservation surgical approaches. Outcome measures were control of disease, postoperative facial nerve function, complications and hearing outcome. Results. A translabyrinthine approach was performed in 59% of cases, hearing preservation surgery in 40% and transmeatal approach in 1%, respectively. Complete resection was achieved in 100% of cases. Overall, postoperative major and minor complications were 8.5% in the series, with complete recovery and no sequalae. Facial nerve function at one year postoperatively was House-Brackmann scale (HB) 1-2 in 95% of cases. The rate of hearing preservation was 70% A-B-C classes of Tokyo classification and 77% AB classes of AAOHNS classification. Conclusions. Early surgery in small vestibular schwannoma is a valid option, due to good functional outcomes, low morbidity and definitive cure. Early surgery is associated with better outcomes when considered in relation to non-surgical treatments reported in the literature.

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Cochlear implant in vestibular schwannomas: long-term outcomes and critical analysis of indications

Cited by 17 publications

References 30 publications

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

Cochlear Implant Outcomes between Patients with Sporadic and Neurofibromatosis Type 2–Associated Vestibular Schwannoma

Early surgery and definitive cure in small sporadic vestibular schwannoma

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