Cochlear patency following translabyrinthine vestibular schwannoma resection: implications for hearing rehabilitation

Carswell, V; Crowther, John A.; Locke, Richard; Taylor, William; Kontorinis, Georgios

doi:10.1017/s0022215119001087

Cited by 11 publications

(11 citation statements)

References 18 publications

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“…24 However, patients considering TL resection may have a more limited timeframe for implantation, as cochlear ossification has been shown to occur in 61% of patients within 6 to 12 months after surgery. 56 As such, simultaneous implantation may maximize the auditory benefit for patients electing TL resection, while also reducing the operative burden and overall resource utilization, even if some patients become nonusers. Electrophysiologic studies of cochlear nerve function may also provide predictive information.…”

Section: Discussionmentioning

confidence: 99%

Twelve‐Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

Doerfer

Fritz

Porps

et al. 2023

Otolaryngol.--head neck surg.

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Objective. Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI).Study Design. Prospective cohort study.Setting. Tertiary referral center.Methods. Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period.Results. AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. Conclusion.Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.

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Section: Discussionmentioning

confidence: 99%

Twelve‐Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

Doerfer

Fritz

Porps

et al. 2023

Otolaryngol.--head neck surg.

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“…Belal described labyrinthine ossification in the membranous labyrinth of a patient found to be profoundly deaf after the MCF approach [13]. This phenomenon has previously been observed in cases of translabyrinthine approaches to vestibular schwannoma resection as well as labyrinthectomy for vestibulopathy [17][18][19]. However, each skull base approach has been shown to produce varying degrees of labyrinthine ossification in the postoperative period [20].…”

Section: Key Pointsmentioning

confidence: 80%

Cochlear implantation: an effective modality for hearing restoration following vestibular schwannoma resection

Doyle

Samy

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewPreservation of hearing is one of the tenets of vestibular schwannoma management. In recent years, cochlear implants have been employed with increasing use in patients who have suffered profound sensorineural hearing loss due to the natural history of vestibular schwannoma or due to injury to neurovascular anatomy at time of surgical resection. Recent findingsCochlear implantation has been found to be an effective modality for hearing restoration following vestibular schwannoma. Simultaneous cochlear implantation has been employed by an increased number of centers around the world and has been shown to provide restoration of open set speech perception and return of binaural hearing. Ongoing use of electrically evoked auditory brainstem response (ABR) has improved our detection of viable cochlear nerves and provided insight into those who would benefit from this procedure. Finally, minimally invasive approaches to the internal auditory canal and intralabyrinthine tumors have been described. These methods frequently employ simultaneous cochlear implantation and have emphasized that hearing preservation remains possible with surgical excision despite the location of the tumor. SummaryCochlear implantation is an effective modality for hearing restoration following vestibular schwannoma excision.

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“…The etiologies for progressive cochlear obliteration after TLA remain unclear, which may result from a combination of different causes including vascular compromise, labyrinthine hemorrhage, red blood cell/protein deposition, labyrinthitis, surgical trauma, or other inflammatory process [Beutner et al, 2015;Rodgers et al, 2017;Hill et al, 2018;Carswell et al, 2019]. The labyrinthine artery, also known as the internal auditory artery, is the main artery supply to the inner ear, vestibulocochlear nerve, and facial nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Vestibular schwannoma is a slow-growing benign tumor that originates from vestibular nerves. Though optimal VS treatment remains subject to debate, options including "Wait-and-Scan", stereotactic radiosurgery and microsurgery, which depend on the location of tumors, tumor size, growth rates, patients' age, and degree of comorbidity [Chamoun et al, 2012;Springborg et al, 2012;Friedmann et al, 2015;Carswell et al, 2019]. Generally, surgery was the treatment of choice for larger tumors and symptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have suggested that partial or total cochlear obliteration (fibrosis or ossification) might develop after TLA due to surgical trauma, inflammation process, or vascular compromise [Beutner et al, 2015;Rodgers et al, 2017;Hill et al, 2018;Carswell et al, 2019]. This kind of labyrinthine fibrosis and ossification process can also be found in middle ear infection, bacterial meningitis, and previous temporal bone trauma/surgery patients.…”

Section: Introductionmentioning

confidence: 99%

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Cochlear Obliteration after Translabyrinthine Resection for Large Cerebellopontine Angle Tumor

et al. 2022

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Introduction: The aim of this study was to better understand the onset time and factors associated with cochlear obliteration following translabyrinthine approach (TLA) surgery for large cerebellopontine angle tumors. Methods: This retrospective cohort study included 117 patients with large cerebellopontine angle tumor (tumor diameter >2 cm) treated by TLA surgery from June 2011 to March 2019 in a single tertiary referral center. The Kaplan-Meier method with log-rank test was used to estimate cochlear patency survival and the association between survival and covariates, and the Cox proportional hazards regression analysis was used to identify possible factors associated with cochlear obliteration. Results: Of the 117 patients included in our analysis, the median follow-up was 24.8 months. There were 30 (25.6%) patients in the cochlear obliteration group, and 87 (74.4%) in the patent cochlear group. Various degrees of cochlear obliteration was found in 25.6% patients in final MRI scan, comprised of 50% grade I, 30% grade II, and 20% grade III. Cochlear patency survival curves showed 94.0% at 3 months, 73.0% at 18 months, which plateaued after 20 months with a survival rate of 71.6%. In the multivariate Cox proportional hazards model, patients presented with postoperative hyperintense T1W cochlear signal had poorer cochlear patency survival compared to isointense T1W (HR = 4.15). Similarly, postoperative deteriorated facial function (HR = 4.52) and full IAC involvement of tumor (HR = 2.33) demonstrated a higher risks of cochlear obliteration after TLA surgery. Conclusion: The 2-year estimated cochlear patency rate was 71.6% in patients that received TLA. Cochlear obliteration can develop as early as 3 months post-surgery, with no new obliteration 20 months after the surgery and half of these patients got severe obliteration. Three factors associated with cochlear obliteration were identified including full IAC involvement of tumor, postoperative facial function deterioration, and postoperative hyperintense T1W cochlear signal.

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Cochlear patency following translabyrinthine vestibular schwannoma resection: implications for hearing rehabilitation

Cited by 11 publications

References 18 publications

Twelve‐Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

Twelve‐Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation

Cochlear implantation: an effective modality for hearing restoration following vestibular schwannoma resection

Cochlear Obliteration after Translabyrinthine Resection for Large Cerebellopontine Angle Tumor

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