Hearing Preservation Following Vestibular Schwannoma Microsurgery
Authors:
M. Chovanec 1
; E. Zvěřina 1; J. Kluh 1; J. Bouček 1; O. Profant 1,2
; Z. Balogová 1,2; J. Syka 2
; J. Betka 1
Authors place of work:
Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha
1; Oddělení neurofyziologie sluchu, Ústav experimentální medicíny AV ČR, v. v. i., Praha
2
Published in the journal:
Cesk Slov Neurol N 2015; 78/111(4): 435-441
Category:
Original Paper
Summary
Aim:
The aim of the study was to conduct a comprehensive analysis of the factors influencing the success rate of hearing preservation in patients undergoing microsurgical removal of vestibular schwannoma (VS).
Materials and methods:
A total of 81 consecutive patients with serviceable hearing underwent surgical removal of unilateral vestibular schwannoma via retrosigmoid-transmeatal approach between 2008 and 2010. Patient, tumor and audiometric parameters together with intraoperative findings were prospectively analyzed. Data were statistically processed including a regression analysis of independent variables.
Results:
Serviceable hearing was preserved in 17 patients (useful hearing in nine and non-useful in eight cases). We observed improvement of hearing from non-useful to useful level in two patients. Average size of VS was smaller in the preserved hearing group (p < 0.001) where lower stage tumors prevailed (p = 0.001). Extent of internal auditory canal filling did not correlate with the result. Preoperative hearing level (p < 0.001) and the type of brainstem auditory evoked response (p = 0.03) arose as significant prognostic factors. Employment of intraoperative BERA was crucial for the outcome (p < 0.001) but success rate of its preservation was not correlated with the result. Identification of the cochlear nerve (p < 0.001), employment of endoscopic technique (p < 0.001), soft consistency of the tumor (p = 0.05) and the lack of adhesions to the neurovascular structures (p < 0.001) proved to be crucial factors affecting the preservation of hearing. Neither hypervascularity nor the presence of cystic component affected outcome.
Conclusions:
Apart from the experience of the surgical team, size of the tumor, preoperative hearing level and possibility of intraoperative hearing monitoring represented the main factors for hearing preservation. Early identification of the cochlear portion of the CN VIII is key. For this, the use of endoscopic technique seems to be beneficial. Soft consistency of tumor and lack of adhesions to the neurovascular structures represent crucial intraoperative factors.
Key words:
vestibular schwannoma – acoustic neuroma – hearing preservation – microsurgery – retrosigmoid approach – intraoperative neuromonitoring
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Zdroje
1. Zvěřina E. Neurinom akustiku – vestibulární schwannom – osobní pohled na nejmodernější postupy v jeho léčbě. Cas Lek Cesk 2010; 149(6): 269– 276.
2. Sughrue ME, Yang I, Aranda D, Lobo K, Pitts LH, Cheung SW et al. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 2010; 112(1): 163– 167. doi: 10.3171/ 2009.4.JNS08895.
3. Samii M, Gerganov V, Samii A. Hearing preservation after complete microsurgical removal in vestibular schwannomas. Prog Neurol Surg 2008; 21: 136– 141. doi: 10.1159/ 000156900.
4. Yang I, Sughrue ME, Han SJ, Aranda D, Pitts LH, Cheung SW et al. A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. J Neurosurg 2010; 112(4): 851– 859. doi: 10.3171/ 2009.8.JNS0985.
5. Rutka J. What would you do if you had a small vestibular schwannoma? An apocryphal tale. Clin Otolaryngol 2008; 33(3): 236– 238. doi: 10.1111/ j.1749‑ 4486.2008.01732.x.
6. Misra BK, Purandare HR, Ved RS, Bagdia AA, Mare PB. Current treatment strategy in the management of vestibular schwannoma. Neurol India 2009; 57(3): 257– 263. doi: 10.4103/ 0028‑ 3886.53263.
7. Morrison D. Management of patients with acoustic neuromas: a Markov decision analysis. Laryngoscope 2010; 120(4): 783– 790. doi: 10.1002/ lary.20819.
8. Holý R, Skutil J, Navar M, Praženica P, Fundová P, Hahn A.Úloha neurootologa v záchytu poradiačních komplikací u pacientů s vestibulárním schwannomem léčených Leksellovým gama nožem. Cesk Slov Neurol N 2013; 76/ 109(2), 191– 196.
9. Holý R, Praženica P, Fundová P, Kovář D, Skutil J, Hahn A. Ovlivnění funkce sluchové dráhy u pacientů s vestibulárním schwannomem léčených Leksellovým gama nožem. Cesk Slov Neurol N 2014; 77/110(2): 223– 229.
10. Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988; 97(1): 55– 66.
11. American Academy of Otolaryngology‑ Head and Neck Surgery Foundation, INC. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 1995; 113(3): 179– 180.
12. Sanna M, Khrais T, Russo A, Piccirillo E, Augurio A. Hearing preservation in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol 2004; 113(2): 156– 163.
13. Wanibuchi M, Fukushima T, McElveen JT jr, Friedman AH.Hearing preservation in surgery for large vestibular schwannomas. J Neurosurg 2009; 111(4): 845– 854. doi: 10.3171/ 2008.12.JNS08620.
14. Lenarz T, Ernst A. Intraoperative monitoring by transtympanic electrocochleography and brainstem electrical response audiometry in acoustic neuroma surgery. Eur Arch Otorhinolaryngol 1992; 249(5): 257– 262.
15. Kluh J, Šmilauer T, Zvěřina E, Betka J. Přínos BERA k diagnostice neurinomů akustiku. Otorinolaryng a Foniat (Praha) 1999; 45(2): 26– 30.
16. Aihara N, Murakami S, Watanabe N, Takahashi M, Inagaki A, Tanikawa M et al. Cochlear nerve action potential monitoring with the microdissector in vestibular schwannoma surgery. Skull Base 2009; 19(5): 325– 332. doi: 10.1055/ s‑ 0029‑ 1220208.
17. Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003; 24(4): 642– 648.
18. Matthies C, Samii M. Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for evaluation and prediction of auditory function in 420 cases. Neurosurgery 1997; 40(5): 919– 929.
19. Chovanec M, Zvěřina E, Profant O, Skřivan J, Čakrt O,Lisý J et al. Impact of video‑ endoscopy on the results of retrosigmoid‑ transmeatal microsurgery of vestibular schwannoma: prospective study. Eur Arch Otorhinolaryngol 2013; 270(4): 1277– 1284. doi: 10.1007/ s00405‑ 012‑ 2112‑ 6.
20. Wiegand DA, Fickel V. Acoustic neuroma‑ the patients perspective: Subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 1989; 99(2): 179– 187.
21. Gauden A, Weir P, Hawthorne G, Kaye A. Systematic review of quality of life in the management of vestibular schwannoma. J Clin Neurosci 2011; 18(12): 1573– 1584. doi: 10.1016/ j.jocn.2011.05.009.
22. Elliott FA, McKissock W. Acoustic neuroma; early diag-nosis. Lancet 1954; 267(6850): 1189– 1191.
23. Wade PJ, House W. Hearing preservation in patients with acoustic neuromas via the middle fossa approach. Otolaryngol Head Neck Surg 1984;w 99(2): 184– 193.
24. Pertuiset B, Maspetiol R, Semette D, Paychere G. La conservation des fonctions auditive et faciale au cours de l‘exerese totale des neurinomas de l‘acoustique par voie sous occipitale. La Presse Medicale 1966; 74(45): 2327– 2330.
25. Jannetta PJ, Møller AR, Møller MB. Technique of hearing preservation in small acoustic neuromas. Ann Surg 1984; 200(4): 513– 523.
26. Zvĕřina E, Fusek I, Kunc Z, Sobota J, Stejskal L. První zkušenosti s mikrochirurgií nádorů n. VIII. Cesk Slov Neurol N 1983; 46/ 79(5): 287– 292.
27. Mrázek J, Paleček T, Wolný E, Mrázková E. Optimální přístupová cesta k tumorům mostomozečkového koutu (univerzální cesta či eklektická filozofie při volbě přístupu?). Otorinolaryng a Foniat (Praha) 2001; 47(3): 152– 155.
28. Skřivan J, Zvĕřina E, Betka J, Kluh J, Kraus J. Our surgical experience with large vestibular schwannomas. Otolaryngol Pol 2004; 58(1): 69– 72.
29. Kari E, Friedman RA. Hearing preservation: microsurgery. Curr Opin Otolaryngol Head Neck Surg 2012; 20(5): 358– 366. doi: 10.1097/ MOO.0b013e3283579673.
30. Somers T, Casselman J, de Ceulaer G, Govaerts P, Offeciers E. Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma. Otol Neurotol 2001; 22(1): 87– 94.
31. Lassaletta L, Fontes L, Melcon E, Sarria MJ, Gavilan J. Hearing preservation with the retrosigmoid approach for vestibular schwannoma: myth or reality? Otolaryngol Head Neck Surg 2003, 129(4): 397– 401.
32. Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112(4): 860– 867. doi: 10.3171/ 2009.7.JNS0989.
33. Rabelo de Freitas M, Russo A, Sequino G, Piccirillo E, Sanna M. Analysis of hearing preservation and facial nerve function for patients undergoing vestibular schwannoma surgery: the middle cranial fossa approach versus the retrosigmoid approach‑ personal experience and literature review. Audiol Neurootol 2012; 17(2): 71– 81. doi: 10.1159/ 000329362.
34. Wanibuchi M, Fukushima T, Friedman AH, Watanabe K, Akiyama Y, Mikami T et al. Hearing preservation surgery for vestibular schwannomas via the retrosigmoid transmeatal approach: surgical tips. Neurosurg Rev 2014; 37(3): 431– 444. doi: 10.1007/ s10143‑ 014‑ 0543‑ 9.
35. Tatagiba M, Roser F, Schuhmann MU, Ebner FH. Vestibular schwannoma surgery via the retrosigmoid transmeatal approach. Acta Neurochir (Wien) 2014(2): 421– 425. doi: 10.1007/ s00701‑ 013‑ 1915‑ 6.
36. Copeland WR, Hoover JM, Morris JM, Driscoll CL, Link MJ. Use of preoperative MRI to predict vestibular schwannoma intraoperative consistency and facial nerve outcome. J Neurol Surg B Skull Base 2013; 74(6): 347– 350. doi: 10.1055/ s‑ 0033‑ 1347369.
37. Sameš M, Vachata P. Complete hearing restoration in vestibular schwannoma with repeated sudden hearing loss. Cesk Slov Neurol N 2010; 73/ 106(3): 299– 302.
38. Shelton C, Hitselberger WE, House WF, Brackmann DE.Hearing preservation after acoustic neuroma removal: long term results. Laryngoscope 1990; 100(2): 115– 119.
39. Friedman RA, Kesser B, Brackmann DE, Fisher LM, Slattery WH, Hitselberger WE. Otolaryngol Head Neck Surg 2003; 129(6): 660– 665.
40. McKenna MJ, Halpin C, Ojemann RG, Nadol JB jr, Montgomery WW, Levine RA, et al. Long‑term hearing results in patients after surgical removal of acoustic tumors with hearing preservation. Am J Otol 1992; 13(2): 134– 136.
41. Tucci DL, Telian SA, Kileny PR, Hoff JT, Kemink JL. Stability of hearing preservation following acoustic neuroma surgery. Am J Otol 1994; 15(2): 183– 188.
42. Chee GH, Nedzelski JM, Rowed D. Acoustic neuroma surgery: the results of long‑term hearing preservation. Otol Neurotol 2003; 24(4): 672– 676.
43. Mazzoni A, Zanoletti E, Calabrese V. Hearing preservation surgery in acoustic neuroma: long‑term results. Acta Otorhinolaryngol Ital 2012; 32(2): 98– 102.
Štítky
Paediatric neurology Neurosurgery NeurologyČlánok vyšiel v časopise
Czech and Slovak Neurology and Neurosurgery
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