Download PDF
Skull Base 2006; 16(3): 133-143
DOI: 10.1055/s-2006-949514
ORIGINAL ARTICLE

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Transmastoid Partial Labyrinthectomy for Brainstem Vascular Lesions: Clinical Outcomes and Assessment of Postoperative Cochleovestibular Function

Michael A. Taplin1 , Richard Anthony1 , Michael Tymianski2 , Michael C. Wallace2 , John A. Rutka1
  • 1Department of Otolaryngology, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
16 August 2006 (online)

    Permissions and Reprints

See also:

Commentary “Transmastoid Partial Labyrinthectomy for Brainstem Vascular Lesions: Clinical Outcomes and Assessment of Postoperative Cochleovestibular Function”Skull Base 2006; 16(03): 142-142
DOI: 10.1055/s-2006-949515

See also:

Commentary “Transmastoid Partial Labyrinthectomy for Brainstem Vascular Lesions: Clinical Outcomes and Assessment of Postoperative Cochleovestibular Function”Skull Base 2006; 16(03): 142-143
DOI: 10.1055/s-2006-949516

ABSTRACT

Objectives: To discuss the transmastoid partial labyrinthectomy approach for brainstem vascular lesions, with respect to hearing and balance preservation. Design: Retrospective case series. Setting: Tertiary referral center (University Health Network, Toronto). Participants: Nine consecutive surgical patients between 1999 and 2004. Main outcome measures: Clinical, audiometric, and electrophysiological vestibular data. Results: Nine transmastoid partial labyrinthectomy procedures (all females) were performed. In seven patients the underlying pathology was an intra-axial brainstem cavernous malformation. Two patients were treated for a basilar artery aneurysm. All patients had progressive neurological signs. Serviceable hearing (pure tone average (PTA): < 50 dB; speech discrimination score (SDS): > 50%) was preserved in seven patients. Partial vestibular function (clinical and electrophysiological) was maintained in most patients. Conclusions: The partial labyrinthectomy approach to the skull base provides excellent exposure while preserving cochleovestibular function in most patients.

KEYWORDS

Partial labyrinthectomy - labyrinthectomy - brainstem cavernoma - hearing preservation - vestibular function

REFERENCES

  • 1 Cawthorne T. The effect on hearing in man of the removal of the membranous lateral semicircular canal.  Acta Otolaryngol Suppl. 1948;  78 145-149
    PubMedGoogle Scholar
  • 2 Jongkees L BW. On the function of the labyrinth after destruction of the horizontal semicircular canal.  Acta Otolaryngol. 1950;  38 505-510
    PubMedGoogle Scholar
  • 3 Canalis R F, Gussen R, Abermayor E, Andrews J. Surgical trauma to the lateral semicircular canal with preservation of hearing.  Laryngoscope. 1987;  97 575-581
    PubMedGoogle Scholar
  • 4 Hakuba A, Nishimura S, Inoue Y. Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas.  Surg Neurol. 1985;  24 405-415
    CrossrefPubMedGoogle Scholar
  • 5 McElveen J T, Wilkins R H, Molter D W, Erwin A C, Wolford R D. Hearing preservation using the modified translabyrinthine approach.  Otolaryngol Head Neck Surg. 1993;  108 671-679
    PubMedGoogle Scholar
  • 6 Parnes L, McClure J. Posterior semicircular canal occlusion in the normal hearing ear.  Otolaryngol Head Neck Surg. 1991;  104 52-57
    PubMedGoogle Scholar
  • 7 Minor L B, Solomon D, Zinreich J S, Zee D S. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal.  Arch Otolaryngol Head Neck Surg. 1998;  124 249-258
    CrossrefPubMedGoogle Scholar
  • 8 Hirsch B E, Cass S P, Sekhar L N, Wright D C. Translabyrinthine approach to skull base tumours with hearing preservation.  Am J Otol. 1993;  14 533-543
    PubMedGoogle Scholar
  • 9 Walsh R M, Bath A P, Cullen J R, Rutka J A. Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo.  Clin Otolaryngol. 1999;  24(4) 316-323
    CrossrefPubMedGoogle Scholar
  • 10 , [No authors listed.] Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma) American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC.  Otolaryngol Head Neck Surg. 1995;  113 179-180
    CrossrefPubMedGoogle Scholar
  • 11 Chanda A, Nanda A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study.  Neurosurgery. 2002;  51 147-160
    CrossrefPubMedGoogle Scholar
  • 12 Sekhar L N, Schessel D A, Bucur S D, Raso J L, Wright D C. Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area.  Neurosurgery. 1999;  44 537-550 discussion 550-552
    PubMedGoogle Scholar
  • 13 Walsh R M, Tymianski M, Wallace M C, Bath A P, Bance M L, Rutka J A. The transmastoid partial labyrinthectomy approach to medial skull base lesions.  Rev Laryngol Otol Rhinol (Bord). 2000;  121 13-20
    PubMedGoogle Scholar
  • 14 Shehab Z P, Walsh R M, Thorp M A, Wallace M C, Tymianski M, Rutka J A. Partial labyrinthectomy approach for brainstem vascular lesions.  J Otolaryngol. 2001;  30 224-230
    PubMedGoogle Scholar
  • 15 Kondziolka D, Lunsford L D, Kestle J R. The natural history of cerebral cavernous malformations.  J Neurosurg. 1995;  83 820-824
    CrossrefPubMedGoogle Scholar
  • 16 Porter R W, Detwiler P W, Spetzler R F et al.. Cavernous malformations of the brainstem: experience with 100 patients.  J Neurosurg. 1999;  90 50-58
    CrossrefPubMedGoogle Scholar
  • 17 Porter P J, Willinsky R A, Harper W, Wallace M C. Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage.  J Neurosurg. 1997;  87 190-197
    CrossrefPubMedGoogle Scholar
  • 18 Kupersmith M J, Kalish H, Epstein F et al.. Natural history of brainstem cavernous malformations.  Neurosurgery. 2001;  48 47-54
    PubMedGoogle Scholar
  • 19 Prepageran N, Kisilevsky V, Tomlinson R D, Ranalli P, Rutka J. Symptomatic high frequency/acceleration vestibular loss: consideration of a new clinical syndrome of vestibular dysfunction.  Acta Otolaryngol. 2005;  125 48-54
    CrossrefPubMedGoogle Scholar
  • 20 Roy F D, Tomlinson R D. Characterization of the vestibulo-ocular reflex evoked by high-velocity movements.  Laryngoscope. 2004;  114 1190-1193
    PubMedGoogle Scholar
  • 21 Colebatch J G, Halmagyi G M. Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation.  Neurology. 1992;  42 1635-1636
    CrossrefPubMedGoogle Scholar
  • 22 Colebatch J G, Halmagyi G M, Skuse N F. Myogenic potentials generated by a click-evoked vestibulocolic reflex.  J Neurol Neurosurg Psychiatry. 1994;  57 190-197
    CrossrefPubMedGoogle Scholar
  • 23 Tsutsumi T, Tsumoda A, Noguchi Y, Komatsuzaki A. Prediction of the nerves of origin of vestibular schwannomas with vestibular evoked myogenic potentials.  Am J Otol. 2000;  21 712-715
    PubMedGoogle Scholar
  • 24 Magliulo G, Gagliardi M, Appiani G C, D'Amico R. Preservation of the saccular nerve and of the vestibular evoked myogenic potential during vestibular schwannoma surgery.  Otol Neurotol. 2003;  24 308-311
    PubMedGoogle Scholar

John A RutkaM.D. 

Department of Otolaryngology, Head and Neck Surgery, University Health Network, Toronto General Hospital, 8N-873

200 Elizabeth St., Toronto, ON M5G 2C4, Canada

Email: john.rutka@uhn.on.ca

      >