Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review

Bartindale, Matthew; Kircher, Matthew; Adams, William; Balasubramanian, Neelam; Liles, Jeffrey; Bell, Jason R.; Leonetti, John

doi:10.1177/0194599817728878

Cited by 30 publications

(23 citation statements)

References 101 publications

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“…Hearing loss after MVD for HFS can occur for the following reasons: stretching of cranial nerve VIII during cerebellar retraction, direct trauma to the nerve caused by instruments or nearby coagulation, outer hair cell dysfunction due to drill-induced noise, compromised blood supply, and bone dust deposit during drilling and fluid entering into the opened mastoid air cell ( 13 , 23 – 25 ). In the present series, the incidence of HL was 4.7%, which was similar to the incidence of 2.7–12% reported in other literature ( 3 , 4 , 13 , 26 , 27 ), but the incidence of permanent HL ( n = 1, 0.6%) was lower than that reported in other literature ( 21 , 28 ). We speculated that it was related to the following factors: (1) a small and lower bone window could better avoid exposure to a mastoid air chamber.…”

Section: Discussionsupporting

confidence: 86%

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Huang

Zhan

et al. 2021

Front. Surg.

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Objective: Microvascular decompression (MVD) surgery has been accepted as a minimally invasive surgical modality for the treatment of hemifacial spasm (HFS). However, the size of the bone window does not match the concept of minimally invasive. This study is aimed at evaluating the efficacy and safety of <2 cm micro-keyhole MVD.Methods: A total of 148 patients with HFS diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019, to July 1, 2020, who underwent MVD in the neurosurgery department of the hospital were collected. Surgery was performed by a retrosigmoid keyhole approach with the bone hole diameter <2 cm, which was named micro-keyhole MVD. The efficacy and safety of the micro-keyhole MVD were evaluated by statistical analysis of the efficacy of the micro-keyhole MVD and the incidence of postoperative complications.Results: The effect of micro-keyhole MVD was satisfying (cure or partial remission) in 97.2% (n = 144). The failure and recurrence rates were 2.7% (n = 4) and 0.6% (n = 1), respectively. Among them, immediate facial palsy, delayed facial palsy, hearing loss, and cerebrospinal fluid (CSF) leakage were found in 0.6% (n = 1), 8.1% (n = 12), 4.7% (n = 7), and 1.3% (n = 2). Only one patient developed cerebellar infarction, which was complicated by “moyamoya disease.” The micro-keyhole MVD in the treatment of HFS can achieve a high remission rate and reduce the incidence of surgical complications.Conclusion: Micro-keyhole MVD is a safe and effective minimally invasive treatment for HFS. This technique does not increase the incidence of cranial nerve injury. Meanwhile, it reduces the incidence of CSF leakage and hearing loss (HL).

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Section: Discussionsupporting

confidence: 86%

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Huang

Zhan

et al. 2021

Front. Surg.

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“…But in fact, compared with studies using Teflon as the implants, the complete cure rate in the REZ-contact group in the present study was similar to or even higher (36,55). The incidence of transient hearing loss, facial palsy in the REZ-contact group was close to or lower than the incidence reported in other large-sample studies (33,36,56). That is, the polyester patch is not inferior to Teflon in terms of effectiveness and safety.…”

Section: Discomforts and Complicationssupporting

confidence: 65%

Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study

Yan

et al. 2021

Ann Transl Med

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Background: Microvascular decompression (MVD) surgery is recognized as an effective treatment for hemifacial spasm (HFS). In MVD surgery, biocompatible materials are usually implanted in situ at the neurovascular conflict site in contact with the offending vessel and the facial root entry/exit zone (REZ).Another procedure of implanting the materials between the responsible vessel and the supraolivary fossa without REZ contact has also been applied. However, it is unclear whether there are any differences between these 2 procedures (REZ-contact procedure vs. REZ-non-contact procedure). Therefore, the aim of the present study was to investigate the effect of the placement of implants (contacting or not contacting the facial REZ) on surgical operations and outcomes Methods: A historical control study was performed. Clinical data of HFS patients who underwent MVD between December 2016 and November 2018 were reviewed and categorized into 1 group with the REZcontact procedure or another group with the REZ-non-contact procedure according to the decompression strategy they received. Clinical demographics, postoperative outcomes, and complications were collected and compared between the two groups.Results: Not all patients are suitable for REZ-non-contact decompression. A total of 205 patients were enrolled: 112 in the REZ-contact group and 93 in the REZ-non-contact group. In the early postoperative period, the complete cure rate in the REZ-non-contact group was significantly higher than that in the REZ-contact group. The reappearance and partial relief rates in the REZ-contact group were significantly higher than those in the REZ-non-contact group. The incidence of short-term neurological complications, especially hearing loss and transient facial palsy, was lower in the REZ-non-contact group (P=0.043). But for long-term follow-up of >1 year, there was no significant difference between the two groups in either curative effects or neurological complications. The operating time for REZ-non-contact decompression was relatively longer than for REZ-contact decompression (P=0.000). An unexpected subdural hemorrhage occurred in the REZ-non-contact group.Conclusions: REZ-non-contact decompression procedure showed superiority only in short-term postoperative outcomes. Given its limitations and potential risks, the REZ-non-contact procedure can be used as an alternative individualized strategy in MVD, and there is no need to pursue REZ-non-contact during the decompression.

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“…Sensorineural hearing loss (SNHL) is more likely permanent and can be potentially caused by stretching of CN VIII while retracting the cerebellum, direct trauma to CN VIII, manipulation of labyrinthine artery or of AICA, new compression of the nerve by the spacer material, and trauma from drill noise or warming. [ 1 , 10 , 18 , 23 , 25 , 26 ] The distinction between CHL and SNHL is critical when the audiogram is performed during the 1 st day after surgery. [ 1 ] Therefore, timing of the audiogram becomes important because an observation period of 2–3 months will allow for middle ear and mastoid fluid to resolve and conductive hearing to normalize in most patients.…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression for typical trigeminal neuralgia: Personal experience with intraoperative neuromonitoring with level-specific-CE-Chirp® brainstem auditory evoked potentials in preventing possible hearing loss

Mastronardi

Caputi

Cacciotti

et al. 2020

Surgical Neurology International

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Background: Permanent hearing loss after posterior fossa microvascular decompression (MVD) for typical trigeminal neuralgia (TTN) is one of the possible complications of this procedure. Intraoperative brainstem auditory evoked potentials (BAEPs) are used for monitoring the function of cochlear nerve during cerebellopontine angle (CPA) microsurgery. Level-specific (LS)-CE-Chirp® BAEPs are the most recent evolution of classical click BAEP, performed both in clinical studies and during intraoperative neuromonitoring (IONM) of acoustic pathways during several neurosurgical procedures. Methods: Since February 2016, we routinely use LS-CE-Chirp® BAEPs for monitoring the function of cochlear nerve during CPA surgery, including MVD for trigeminal neuralgia. From September 2011 to December 2018, 71 MVDs for TTN were performed in our department, 47 without IONM of acoustic pathways (Group A), and, from February 2016, 24 with LS-CE-Chirp BAEP (Group B). Results: Two patients of Group A developed a permanent ipsilateral anacusia after MVD. In Group B, we did not observe any permanent acoustic deficit after surgery. In one case of Group B, during arachnoid dissection, intraoperative LS-CE-Chirp BAEP showed a temporary lag of V wave, resolved in 5 min after application of intracisternal diluted papaverine (0.3% solution without excipients). Conclusion: MVD is widely considered a definitive surgical procedure in the management of TTN. Even though posterior fossa MVD is a safe procedure, serious complications might occur. In particular, the use of IONM of acoustic pathways during MVD for TTN might contribute to prevention of postoperative hearing loss.

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Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review

Cited by 30 publications

References 101 publications

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study

Microvascular decompression for typical trigeminal neuralgia: Personal experience with intraoperative neuromonitoring with level-specific-CE-Chirp® brainstem auditory evoked potentials in preventing possible hearing loss

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