Long-Term Hearing Outcome After Retrosigmoid Removal of Vestibular Schwannoma

Nakamizo, Akira; Mori, Megumu; Inoue, Daisuke; Amano, Toshiyuki; Mizoguchi, Masahiro; Yoshimoto, Koji; Sasaki, Tatsuya

doi:10.2176/nmc.oa2012-0351

Cited by 20 publications

(11 citation statements)

References 33 publications

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“…The hearing deterioration was observed in 14.3 % of cases. Similar results were presented by Nakamizo et al [ 6 ]. From 57 patients with the serviceable preoperative hearing, 28 retained the hearing after surgery.…”

Section: Discussionsupporting

confidence: 92%

“…However, a hearing functionality in the short term after the surgery may worsen in the postoperative observation. A deterioration of hearing was observed by many authors [ 1 , 2 , 6 , 9 ]. The frequency of this fact has a wide range from 0 to 56 % [ 1 , 2 , 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…There exist a few explanations of this phenomenon. One of them is a damage of the endolymphatic duct (ED) or sac (ES) during removal of the posterior wall of the internal acoustic meatus (IAM) [ 1 , 2 , 6 , 9 ]. Some authors observed that the obstruction of the endolymph flow through ED causes slow, but progressive hearing deterioration and symptoms similar to Meniere’s disease.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

et al. 2016

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PurposeDuring vestibular schwannoma surgery there is a risk of endolymphatic duct and sac injury, which may cause a loss or a deterioration of hearing. The goal of the study was to evaluate the empirical utility of presurgical planning using CT with the bone window for the hearing preservation surgery.MethodsThe study was performed on 14 human temporal bones. CT scans with the bone window were obtained in the standard position. Safe drilling line was evaluated and after that drilling distances were analysed: the lateral drilling distance, total length of internal acoustic meatus, drilled length of internal acoustic meatus. After this, a surgical exposure was performed, using size of a drill tip as measuring scale. The dura was excised and endolymphatic duct was injected with a latex. Revision of the internal acoustic meatus was performed with the use of a microscope.ResultsMean results of safe drilling coefficients were: lateral drilling distance: 10 ± 2 mm, total length of internal acoustic meatus: 9 ± 2 mm, drilled length of internal acoustic meatus: 7 ± 2 mm. In all cases, no endolymphatic duct injury was observed.ConclusionsPreoperative radiological planning using the safe drilling coefficients is of value for the hearing preservation surgery in vestibular schwannoma. The size of the drilling tip may be used as an intraoperative measuring scale during this procedure. However, CT with a bone window is a necessary tool for the purposes of this procedure.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

et al. 2016

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“…A retrosigmoid approach is the conventional approach for treating CP angle lesions, e.g., acoustic neuroma, meningioma, epidermoid, hemifacial spasm, trigeminal neuralgia, and intrinsic brain stem tumors. [6][7][8][9][10][11][12][13][14][15][16][17] Since Rand and Kurze introduced the microscope to remove acoustic neurinoma in 1957, the retrosigmoid approach has been used mainly using a microscope. 18) When using a microscope, the retrosigmoid approach is generally performed in lateral, lateral oblique, sitting, semi-sitting, supine, or park bench positions.…”

Section: Discussionmentioning

confidence: 99%

Retrosigmoid Approach in the Supine Position Using ORBEYE: A Consecutive Series of 14 Cases

Shimizu

Toyota

Nakagawa

et al. 2020

Neurol. Med. Chir.(Tokyo)

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One of the merits of recently introduced exoscopes, including ORBEYE, is that they are superior to a conventional microscope in terms of ergonomic features. Taking advantage of it, the retrosigmoid approach can be performed in the supine position using ORBEYE. We report a consecutive series of 14 operations through the retrosigmoid approach in the supine position using ORBEYE. Fourteen consecutive patients who underwent surgery through the retrosigmoid approach for cerebellopontine (CP) angle lesions in the supine position using ORBEYE were targeted, and surgical outcomes and complications were examined. We evaluated the posture of the operator and the surgical field during this approach compared with those using a conventional microscope. In all 14 cases, all operative procedures were accomplished only using the ORBEYE. There were no operative complications due to this approach. Using ORBEYE, even when the angle of the operative visual axis was horizontal, the operators could manipulate in a comfortable posture. They were not forced to be in an uncomfortable posture that extended their arms, as is often the case with a conventional microscope. Therefore, they could use shorter surgical instruments. As the cerebellum shifted downward with gravity even using slight retraction during this approach, the working space of the surgical field was easily secured. Through this approach, the operators can perform stable microsurgery of CP angle lesions in a comfortable posture. This approach can reduce the burden on the operator and the patient, leading to a refined surgical procedure.

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“…The reported functional hearing outcomes should be carefully interpreted in correlation with the duration of the postintervention follow-up period since progressive hearing deterioration over time has been reported in up to 20%-30% of the patients at the 5-year follow-up. 33 A chronic vascular ischemic mechanism has been proposed to explain this phenomenon. 46 Hearing preservation after SRS for small-to mediumsized VSs was reported in more than 70% of patients with VSs and in up to 90% in those with intracanalicular tumor.…”

Section: Hearing Preservationmentioning

confidence: 99%

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

Starnoni

Daniel

Tuleasca

et al. 2018

Neurosurgical Focus

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OBJECTIVEDuring the last decade, the primary objective for large vestibular schwannoma (VS) management has progressively shifted, from tumor excision to nerve preservation by using a combined microsurgical and radiosurgical approach. The aim of this study was to provide a systematic review and meta-analysis of the available literature regarding the combined strategy of subtotal resection (STR) followed by stereotactic radiosurgery (SRS) for large VSs.METHODSThe authors performed a systematic review and meta-analysis in compliance with the PRISMA guidelines for article identification and inclusion using the PubMed, Embase, and Cochrane databases. Established inclusion criteria were used to screen all identified relevant articles published before September 2017 without backward date limit.RESULTSThe authors included 9 studies (248 patients). With a weighted mean follow-up of 46 months (range 28–68.8 months), the pooled rate of overall tumor control was 93.9% (95% CI 91.0%–96.8%). Salvage treatment (second STR and/or SRS) was necessary in only 13 (5.24%) of 18 patients who experienced initial treatment failure. According to the House-Brackmann (HB) grading scale, functional facial nerve preservation (HB grade I–II) was achieved in 96.1% of patients (95% CI 93.7%–98.5%). Serviceable hearing after the combined approach was preserved in 59.9% (95% CI 36.5%–83.2%).CONCLUSIONSA combined approach of STR followed by SRS was shown to have excellent clinical and functional outcomes while still achieving a tumor control rate comparable to that obtained with a total resection. Longer-term follow-up and larger patient cohorts are necessary to fully evaluate the rate of tumor control achieved with this approach.

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Long-Term Hearing Outcome After Retrosigmoid Removal of Vestibular Schwannoma

Cited by 20 publications

References 33 publications

Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

Retrosigmoid Approach in the Supine Position Using ORBEYE: A Consecutive Series of 14 Cases

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

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