Simultaneous translabyrinthine removal of acoustic neuroma and cochlear implantation
Introduction
Following the progressive refinements of the surgical techniques for acoustic neuroma (AN) removal, hearing preservation has become a standard procedure in most otoneurosurgical units. The anatomical sparing of the cochlear branch of the VIIIth nerve is an essential prerequisite, although not always sufficient to guarantee an efficient auditory function [1]. Various surgical approaches with special precautions and methods have been proposed in order to increase the rates of hearing preservation [2], [3], [4].
When hearing is lost after surgery for a unilateral AN, a cochlear implant (CI) would be a logical solution for the acoustic rehabilitation, provided the cochlear nerve has been maintained intact. Intraoperative electrophysiological monitoring of the auditory pathways is helpful in this respect.
Since the indications for CI have been greatly expanded in the last decade, a planned AN removal with simultaneous or subsequent cochlear implantation have been suggested by many authors [1], [5], [6], [7].
We describe the results of hearing restoration by means of a cochlear implant inserted at the same time of the removal of an acoustic neuroma in a woman with long-standing bilateral Meniere's disease.
Section snippets
Materials, methods and case report
Among 104 patients who underwent AN surgery at the Otorhinolaryngologic Department of the University of Brescia, between 1999 and 2006, where a cochlear implants (CI) program is running since 2002 with 83 recipients, one 65-year-old woman was affected by bilateral Meniere's disease with a long history of recurrent vertigo spells and progressive hearing deterioration. Over the last 20 years she had suffered from bilateral Meniere's disease (MD) with recurrent vertigo spells (2–3 crises per year)
Discussion
The options for treatment of vestibular schwannoma nowadays include simple observation, hearing preservation surgery and radiation therapy [9]. Three approaches are mainly used for surgical resection: translabyrinthine, retrosigmoid and via the middle cranial fossa. While the former is a destructive procedure, the two latter allow preservation of the inner ear and neural structures.
In small tumours, i.e. intracanalicular or with less than 1 cm intracisternal extension, and useful hearing, i.e.
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