Cochleovestibular Nerve Compression Syndrome Caused by Intrameatal Anterior Inferior Cerebellar Artery Loop: Synthesis of Best Evidence for Clinical Decisions

Esposito, Giacomo; Messina, Raffaella; Carai, Andrea; Colafati, Giovanna Stefania; Savioli, A.; Randi, Franco; Benedictis, Alessandro De; Cossu, Silvia; Fontanella, Marco Maria; Marras, Carlo Efisio

doi:10.1016/j.wneu.2016.09.030

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…All nine suffered from tinnitus and, of these, two from vertigo and one from unilateral hearing loss. Tinnitus and vertigo resolved after surgery but the hearing loss did not improve [ 18 ]. Hearing loss could, therefore, be a sign of more chronic compression leading to irreversible nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex

Alonso

Kassem

Iwanaga

et al. 2017

Cureus

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Vascular loops in the cerebellopontine angle (CPA) and their relationship to cranial nerves have been used to explain neurological symptoms. The anterior inferior cerebellar artery (AICA) has variable branches producing vascular loops that can compress the facial cranial nerve (CN) VII and vestibulocochlear (CN VIII) nerves. AICA compression of the facial-vestibulocochlear nerve complex can lead to various clinical presentations, including hemifacial spasm (HFS), tinnitus, and hemiataxia. The formation of arterial loops inside or outside of the internal auditory meatus (IAM) can cause abutment or compression of CN VII and CN VIII.Twenty-five (50 sides) fresh adult cadavers underwent dissection of the cerebellopontine angle in the supine position. In regard to relationships between the AICA and the nerves of the facial/vestibulocochlear complex, 33 arteries (66%) traveled in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Five arteries (10%) traveled below the CN VII/VIII complex, six (12%) traveled posterior to the nerve complex, four (8%) formed a semi-circle around the upper half of the nerve complex, and two (4%) traveled between and partially separated the nervus intermedius and facial nerve proper. Our study found that the majority of AICA will travel in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Although the relationship between the AICA and porus acusticus and AICA and the nerves of the CN VII/VIII complex are variable, based on our findings, some themes exist. Surgeons should consider these with approaches to the cerebellopontine angle.

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Section: Discussionmentioning

confidence: 99%

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex

Alonso

Kassem

Iwanaga

et al. 2017

Cureus

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“…Surgical decompression, however, was found to have no effect on hearing loss. 20 In addition, the relatively high (11%) complication Because tinnitus and vertigo may coexist due to a pathological process other than CN8 NVC (eg, vestibular schwannomas or endolymphatic sac tumors), MRI is indicated if we suspect a NVC, before carrying out an MVD. The MRI should exclude alternative etiologies, prove the presence of a CN8 NVC, and add anatomical information about the approach to the CPA.…”

Section: Discussionmentioning

confidence: 99%

The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss

Ungar

Brenner‐Ullman

Cavel

et al. 2018

Laryngoscope Investig Oto

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HypothesisThere may be an association between a neurovascular conflict (NVC) of the auditory nerve and unilateral sudden sensorineural hearing loss (SSNHL).BackgroundCompression of cranial nerves by vascular structures can lead to significant symptomatology that may require surgical decompression. Notable examples are trigeminal neuralgia and hemifacial spasm. Magnetic resonance imaging (MRI) is part of the workup for SSNHL, and it may depict an NVC of the auditory nerve. Here we look into the association between this NVC and unilateral SSNHL.MethodsA retrospective analysis was performed on all consecutive patients with unilateral SSNHL who underwent an MRI scan in our medical center. The data collected included age, gender, side and severity of hearing loss, and accompanying complaints. Each MRI scan was reviewed by a neuroradiologist who was unaware of hearing loss laterality. The presence, side, extent, and location of a potential NVC involving the auditory nerve were determined, and a correlation between radiological findings and auditory parameters was sought.ResultsFifty‐four patients (male‐to‐female ratio 26:28, age range 25–80 years) were enrolled into the study. Fourteen of them (25.9%) had normal MRI findings. Twenty‐six patients had a unilateral NVC, and the pathology was ipsilateral to the side of hearing loss in only 12 of them (46.2%). Fourteen (25.9%) patients had MRI findings of bilateral NVCs. There was no significant correlation between the side of the SSNHL and any radiological findings (P = .314).ConclusionThe data presented herein support the conclusion that there is no association between CN8 NVC and unilateral SSNHL.Level of Evidence2b.

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“…Continuous or pulsatile tinnitus may be due to variety of pathologies, such as tumours of cerebellopontine angle and vascular pathologies, including dural AV fistula (DAVF), intracranial aneurysms, atherosclerotic diseases of intracranial vessels, and medical conditions with high cardiac output (such as hypertension, anaemia or thyreotoxicosis) (3,4,7,10). Vascular conflict with eighth cranial nerve is another possible cause of tinnitus.…”

Section: Introductionmentioning

confidence: 99%

“…More than 500 cases of microvascular decompression surgery of eighth nerve have been described to date in the literature. However, there are less than 10 surgically treated cases of tinnitus due to intrameatal anterior inferior cerebellar artery (4). None of these cases were paediatric.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are only a few cases of surgically treated tinnitus due to intrameatal AICA loop, surgical treatment resolved tinnitus in all cases as in our case. Hence, surgery could be a valid option for selected cases with unilateral pulsatile tinnitus and radiologically confirmed intrameatal vascular conflict(4,9,11). Proper patient selection is however crucial.ConclusionDecompression of the cochleovestibular nerve including opening of IAC and transposition of AICA seems to be an effective treatment option for cases with radiologically confirmed intrameatal vascular compression of eighth nerve causing unilateral pulsatile tinnitus.…”

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confidence: 99%

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Surgical Treatment of Pediatric Unilateral Tinnitus Due to Cochleovestibular Nerve Compression by Intrameatal Anterior Inferior Cerebellar Artery Loop

2019

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Objectives: Cochleovestibular nerve compression syndrome due to intrameatal anterior inferior cerebellar artery (AICA) that causes tinnitus is an extremely rare condition with special therapeutic challenges and implications. Here we present the first surgically treated paediatric case of tinnitus showing microvascular conflict of cochleovestibular nerve and intrameatal AICA loop. Methods: A paediatric case of tinnitus is described and a surgical technique is elaborated with video material. A Pubmed literature search was performed to identify surgically treated paediatric cases of intrameatal compression of eighth nerve with AICA loop. Results: Tinnitus was completely resolved and hearing was intact immediately after surgical decompression. The patient was free from further symptoms after a short follow up of 12 weeks. Microsurgical decompression, including opening of IAC and transposition of AICA, was an effective treatment option in this case. Conclusion: Decompression of the cochleovestibular nerve including opening of IAC and transposition of AICA appears to be an effective treatment option for cases with radiologically confirmed intrameatal vascular compression of eighth nerve causing unilateral pulsatile tinnitus.

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Cochleovestibular Nerve Compression Syndrome Caused by Intrameatal Anterior Inferior Cerebellar Artery Loop: Synthesis of Best Evidence for Clinical Decisions

Cited by 11 publications

References 26 publications

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex

The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss

Surgical Treatment of Pediatric Unilateral Tinnitus Due to Cochleovestibular Nerve Compression by Intrameatal Anterior Inferior Cerebellar Artery Loop

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