Elsevier

Auris Nasus Larynx

Volume 35, Issue 4, December 2008, Pages 562-568
Auris Nasus Larynx

Simultaneous translabyrinthine removal of acoustic neuroma and cochlear implantation

https://doi.org/10.1016/j.anl.2007.11.011Get rights and content

Abstract

Objectives

To report of a 65-year-old woman with bilateral Meniere's disease was referred for cochlear implantation (CI) due to severe/profound sensorineural hearing loss.

Methods

During the assessment workup, a vestibular schwannoma in the right ear was found by MR imaging. She underwent a translabyrinthine removal of the acoustic neuroma (AN) with sparing of the cochlear nerve and concurrent ipsilateral CI with a Nucleus Freedom device (Cochlear Ltd., Lane Cove, New South Wales, Australia).

Results

Complete removal of the AN was achieved without complications. Neural Response Telemetry (NRT) measurements, which showed poor morphology at the intraoperative tests, rapidly improved after activation, similarly to electrically evoked auditory brainstem responses (E-ABR). The patient reached 100% speech perception performances within 2 months from implantation, in the monaural condition. She was relieved from vertigo spell up to 14 months after the operation.

Conclusion

Cochlear implantation at the time of acoustic neuroma removal with VIII nerve sparing can be a safe and effective hearing restoration procedure.

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.

References (30)

  • M. Arriaga et al.

    Simultaneous cochlear implantation and acoustic neuroma resection: imaging considerations, technique and functional outcome

    Otolaryngol Head Neck Surg

    (1995)
  • D.C. Bloch et al.

    The fate of the tumour remnant after less-than-complete acoustic neuroma resection

    Otolaryngol Head Neck Surg

    (2004)
  • R. Hoffman et al.

    Cochlear implants in the management of bilateral acoustic neuromas

    Am J Otol

    (1992)
  • C.S. Hecht et al.

    Hearing preservation after acoustic neuroma resection with tumour size used as a clinical prognosticator

    Laryngoscope

    (1997)
  • K.R. Stidham et al.

    Hearing improvement after middle fossa resection of vestibular schwannoma

    Otol Neurotol

    (2001)
  • M. Arìstegui et al.

    Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of two cases (neurofibromatosis type 2 and unilateral vestibular schwannoma)

    Otol Neurotol

    (2005)
  • Y.J. Shin et al.

    Hearing restoration in posterior fossa tumours

    Am J Otol

    (1998)
  • F. Hulka et al.

    Cochlear implantation in a patient after removal of an acoustic neuroma. The implications of magnetic resonance imaging with gadolinium on patient management

    Arch Otolaryngol Head Neck Surg

    (1995)
  • T. Tono et al.

    Cochlear implantation in an intralabyrinthine acoustic neuroma patient after resection of an intracanalicular tumour

    Adv Otorhinolaryngol

    (1997)
  • S. Burdo et al.

    Test per le Abilita‘ Uditive di Varese

    I Care

    (1995)
  • L.R. Lustig et al.

    Cochlear implantation in patients with bilateral Ménière's disease

    Otol Neurotol

    (2003)
  • Committee on Hearing and Equilibrium. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing...
  • M. Sanna et al.

    Hearing preservation surgery in vestibular schwannoma: the hidden truth

    Ann Otol Rhinol Laryngol

    (2004)
  • M.S. Robinette et al.

    Nonsurgical factors predictive of postoperative hearing for patients with vestibular schwannoma

    Am J Otol

    (1997)
  • P.J. Govaerts et al.

    Outcome of cochlear implantation at different ages from 0–6 years

    Otol Neurotol

    (2002)
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