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Hearing preservation in surgery for large vestibular schwannomas

Clinical article

Masahiko Wanibuchi Carolina Neuroscience Institute and
Carolina Ear Research Institute, Raleigh; and
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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M.D., Ph.D.
,
Takanori Fukushima Carolina Neuroscience Institute and
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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M.D., D.M.Sc.
,
John T. McElveen Jr. Carolina Ear Research Institute, Raleigh; and

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M.D.
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Allan H. Friedman Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

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Object

Hearing preservation remains a challenging problem in vestibular schwannoma (VS) surgery. The ability to preserve hearing in patients with large tumors is subject to particular difficulty. In this study, the authors focus on hearing preservation in patients harboring large VSs.

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A total of 344 consecutive patients underwent surgical removal of VSs over the past 9 years. Of these 344 cases, 195 VSs were > 20 mm in maximum cisternal diameter. Of the 195 cases, hearing preservation surgery was attempted for 54 patients who had a Class A, B, C, or D preoperative hearing level; that is, a pure tone average ≤ 60 dB and speech discrimination score ≥ 50% according to the Sanna/Fukushima classification. The tumors were classified as moderately large (21–30 mm based on the largest extrameatal diameter), large (31–40 mm), and giant (≥ 41 mm) according to the international criteria. The authors categorized patients with Class A, B, C, D, or E hearing (pure tone average ≤ 80 dB and speech discrimination score ≥ 40%) as having preserved hearing postoperatively.

Results

Forty-one tumors (75.9%) were totally removed and 13 (24.1%) had near-total removal. Of the 54 patients, 29 maintained their hearing postoperatively; the overall hearing preservation rate was 53.7%. Analysis based on the preoperative hearing level showed that hearing was preserved in 14 (77.8%) of 18 cases for Class A; in 8 (47.1%) of 17 cases for Class B; in 4 (57.1%) of 7 cases for Class C; and in 3 (25.0%) of 12 cases for Class D. In addition, according to the analysis based on the tumor size, 20 (52.6%) of 38 patients with moderately large tumors retained their hearing, as did 5 (50.0%) of 10 patients with large tumors and 4 (66.7%) of 6 patients with giant tumors. Complications included 2 cases of bacterial meningitis that were cured by intravenous injection of antibiotics, 3 cases of subcutaneous CSF leakage that resolved without any surgical repair, and 1 case of temporary abducent nerve palsy. There were no deaths in this series.

Conclusions

The results indicate that successful hearing preservation surgery in large VSs is possible with meticulous technique and attention to adhesions between the tumor and the cochlear nerves.

Abbreviations used in this paper:

AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery ; BAEP = brainstem auditory evoked potential ; IAC = internal auditory canal ; PTA = pure tone average ; SDS =言语歧视得分 ; VS = vestibular schwannoma .
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  • 1

    ChungWY,,LiuKD,,ShiauCY,,WuHM,,WangLW,&GuoWY,et al.:Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases.J Neurosurg102:Suppl8796,2005

    • Search Google Scholar
    • Export Citation
  • 2

    CohenNL,,刘易斯WS,&RansohoffJ:Hearing preservation in cerebellopontine angle tumor surgery: the NYU experience 1974–1991.Am J Otol14:423433,1993

    • Search Google Scholar
    • Export Citation
  • 3

    Committee on Hearing and Equilibrium:Committee on hearing and equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma).Otolaryngol Head Neck Surg113:179180,1995

    • Search Google Scholar
    • Export Citation
  • 4

    ElliottFA,&McKissockW:Acoustic neuroma; early diagnosis.Lancet267:11891191,1954

  • 5

    FahlbuschR,,NeuM,&StraussC:Preservation of hearing in large acoustic neurinomas following removal via suboccipitolateral approach.Acta Neurochir (Wien)140:771778,1998

    • Search Google Scholar
    • Export Citation
  • 6

    FischerG,,FischerC,&RémondJ:Hearing preservation in acoustic neurinoma surgery.J Neurosurg76:910917,1992

  • 7

    FukushimaT,Patient selection and method of evaluation for hearing preservation in acoustic neuroma surgery.KanzakiL,,TosM,,SannaM,,莫法特DA,,KunihiroT,&InoueY:Acoustic Neuroma: Consensus on Systems for Reporting ResultsNew York,Springer,2003.183192

    • Search Google Scholar
    • Export Citation
  • 8

    GoelA,,SekharLN,,LangheinrichW,,KamererD,&HirschB:Late course of preserved hearing and tinnitus after acoustic neurilemoma surgery.J Neurosurg77:685689,1992

    • Search Google Scholar
    • Export Citation
  • 9

    GormleyWB,,SekharLN,,WrightDC,,KamererD,&SchesselD:Acoustic neuromas: Results of current surgical management.开云体育app官方网站下载入口41:5060,1997

    • Search Google Scholar
    • Export Citation
  • 10

    HainesSJ:Levine SC: Intracanalicular acoustic neuroma: early surgery for preservation of hearing.J Neurosurg79:515520,1993

    • Search Google Scholar
    • Export Citation
  • 11

    HarnerSG,,LawaJR,&OnofrioBM:Hearing preservation after removal of acoustic neurinoma.Laryngoscope94:14311434,1984

    • Search Google Scholar
    • Export Citation
  • 12

    HechtCS,,何nrubiaVF,,WietRJ,&SimsHS:Hearing preservation after acoustic neuroma resection with tumor size used as a clinical prognosticator.Laryngoscope107:11221126,1997

    • Search Google Scholar
    • Export Citation
  • 13

    HintonAE,,RamsdenRT,,LyeRH,&DuttonJE:Criteria for hearing preservation in acoustic schwannoma surgery: the concept of useful hearing.J Laryngol Otol106:500503,1992

    • Search Google Scholar
    • Export Citation
  • 14

    何useJW,&BrackmannDE:Facial nerve grading system.Otolaryngol Head Neck Surg93:146147,1985

  • 15

    InoueHK:Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation.J Neurosurg102:Suppl111113,2005

    • Search Google Scholar
    • Export Citation
  • 16

    IwaiY,,YamanakaK,,ShiotaniM,&UyamaT:Radiosurgery for acoustic neuromas: results of low-dose treatment.开云体育app官方网站下载入口53:282288,2003

    • Search Google Scholar
    • Export Citation
  • 17

    KanzakiJ,Results of Questionnaires of Reporting System.KanzakiL,,TosM,,SannaM,,莫法特DA,,KunihiroT,&InoueY:Acoustic Neuroma: Consensus on Systems for Reporting ResultsTokyo,Springer,2003.183192

    • Search Google Scholar
    • Export Citation
  • 18

    KerminkJL,,LaRouereMJ,,KilenyPR,,TelianSA,&何ffJT:Hearing preservation following suboccipital removal of acoustic neuromas.Laryngoscope100:597602,1990

    • Search Google Scholar
    • Export Citation
  • 19

    LanmanTH,,BrackmannDE,,HitselbergerWE,&SubinB:Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach.J Neurosurg90:617623,1999

    • Search Google Scholar
    • Export Citation
  • 20

    LeeSH,,WillcoxTOJ,&BuchheitWA:Current results of the surgical management of acoustic neuroma.Skull Base12:189196,2002

    • Search Google Scholar
    • Export Citation
  • 21

    LunsfordLD,,NiranjanA,,FlickingerJC,,MaitzA,&KondziolkaD:Radiosurgery of vestibular schwannomas: summary of experience in 829 cases.J Neurosurg102:Suppl195199,2005

    • Search Google Scholar
    • Export Citation
  • 22

    MamikogluB,,WeitRJ,&EsquivelCR:Translabyrinthine approach for the management of large and giant vestibular schwannomas.Otol Neurotol23:224227,2002

    • Search Google Scholar
    • Export Citation
  • 23

    MatthiesC,&SamiiM:Vestibular schwannomas and auditory function: options in large T3 and T4 tumors?.Neurochirurgie48:461470,2002

    • Search Google Scholar
    • Export Citation
  • 24

    MawAR,,CoakhamHB,,AyoubO,&ButlerSR:Hearing preservation and facial nerve function in vestibular schwannoma surgery.Clin Otolaryngol28:252256,2003

    • Search Google Scholar
    • Export Citation
  • 25

    McElveenJT,,BelmonteRG,,FukushimaT,&BullardDE:A review of facial nerve outcome in 100 consecutive cases of acoustic tumor surgery.Laryngoscope110:16671672,2000

    • Search Google Scholar
    • Export Citation
  • 26

    McKennaMJ,,HalpinC,,OjemanRG,,NadolJBJr,,MontgomeryWW,&LevineRA,et al.:Long-term hearing results in patients after surgical removal of acoustic tumors with hearing preservation.Am J Otol13:134136,1992

    • Search Google Scholar
    • Export Citation
  • 27

    莫法特DA,,da CruzMJ,,BaguleyDM,,BeynonGJ,&HardyDG:Hearing preservation in solitary vestibular schwannoma surgery using the retrosigmoid approach.Otolaryngol Head Neck Surg121:781788,1999

    • Search Google Scholar
    • Export Citation
  • 28

    MohrG,,SadeB,,DufourJJ,&RappaportJM:Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling.J Neurosurg102:15,2005

    • Search Google Scholar
    • Export Citation
  • 29

    MoriyamaT,,FukushimaT,,AsaokaK,,RochePH值,,BarrsDM,&McElveenJTJr:Hearing preservation in acoustic neuroma surgery: importance adhesion between the cochlear nerve and the tumor.J Neurosurg97:337340,2002

    • Search Google Scholar
    • Export Citation
  • 30

    PetitJH,,HudesRS,,ChenTT,,EisenbergHM,,SimardJM,&ChinLS:Reduced-dose radiosurgery for vestibular schwannomas.开云体育app官方网站下载入口49:12991307,2001

    • Search Google Scholar
    • Export Citation
  • 31

    PostKD,,EisenbergMB,&CatalanoPJ:听力保护前庭神经鞘瘤杂志ery: what factors influence outcome?.J Neurosurg83:191196,1995

    • Search Google Scholar
    • Export Citation
  • 32

    PrasadD,,SteinerM,&SteinerL:Gamma surgery for vestibular schwannoma.J Neurosurg92:745759,2000

  • 33

    Rohit体育,,JainY,,AugurioA,&SannaM:Preoperative predictive factors for hearing preservation in vestibular schwannoma surgery.Ann Otol Rhinol Laryngol115:4146,2006

    • Search Google Scholar
    • Export Citation
  • 34

    RuttenI,,BaumertBG,,SeidelL,,KotolenkoS,,CollignonJ,&KaschtenB,et al.:Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma.Radiother Oncol82:8389,2007

    • Search Google Scholar
    • Export Citation
  • 35

    SamiiM,,GerganovV,&SamiiA:Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients.J Neurosurg105:527535,2006

    • Search Google Scholar
    • Export Citation
  • 36

    SamiiM,&MatthiesC:Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections.开云体育app官方网站下载入口40:248262,1997

    • Search Google Scholar
    • Export Citation
  • 37

    SannaM,,KarmarkarS,&LandolfiM:听力保护前庭神经鞘瘤杂志ery: fact or fantasy?.J Laryngol Otol109:374380,1995

    • Search Google Scholar
    • Export Citation
  • 38

    SannaM,,KhraisT,,RussoA,,PiccirilloE,&AugurioA:Hearing preservation surgery in vestibular schwannoma: the hidden truth.Ann Otol Rhinol Laryngol113:156163,2004

    • Search Google Scholar
    • Export Citation
  • 39

    SheltonC,,HitselbergerWE,,何useWF,&BrackmannDE:Hearing preservation after acoustic tumor removal: long-term results.Laryngoscope100:115119,1990

    • Search Google Scholar
    • Export Citation
  • 40

    ShinM,,UekiK,,KuritaH,&KirinoT:Malignant transformation of a vestibular schwannoma after Gamma Knife radiosurgery.Lancet360:309310,2002

    • Search Google Scholar
    • Export Citation
  • 41

    SilversteinH,,RosenbergSI,,FlanzerJM,,WanamakerHH,&SeidmanMD:An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms.Otolaryngol Head Neck Surg108:110,1993

    • Search Google Scholar
    • Export Citation
  • 42

    SpiegelmannR,,LidarZ,,GofmanJ,,AlezraD,,HadaniM,&PfefferR:Linear accelerator radiosurgery for vestibular schwannoma.J Neurosurg94:713,2001

    • Search Google Scholar
    • Export Citation
  • 43

    SuhJH,,BarnettGH,,SohnJW,,Kupelian巴勒斯坦权力机构,&CohenBH:Results of linear accelerator-based stereotactic radiosurgery for recurrent and newly diagnosed acoustic neuromas.Int J Cancer90:145151,2000

    • Search Google Scholar
    • Export Citation
  • 44

    TatorCH,&NedzelskiJM:Preservation of hearing in patients undergoing excision of acoustic neuromas and other cerebellopontine angle tumors.J Neurosurg63:168174,1985

    • Search Google Scholar
    • Export Citation
  • 45

    UmezuH,&AibaT:Preservation of hearing after surgery for acoustic schwannomas: correlation between cochlear nerve function and operative findings.J Neurosurg80:844848,1994

    • Search Google Scholar
    • Export Citation
  • 46

    WeberDC,,ChanAW,,BussiereMR,,HarshGRIV,,AncukiewiczM,&BarkerFGII,et al.:Proton beam radiosurgery for vestibular schwannoma: tumor control and cranial nerve toxicity.开云体育app官方网站下载入口53:577588,2003

    • Search Google Scholar
    • Export Citation
  • 47

    WietRJ,,MamikogluB,,OdomL,&何istadDL:Long-term results of the first 500 cases of acoustic neuroma surgery.Otolaryngol Head Neck Surg124:645651,2001

    • Search Google Scholar
    • Export Citation
  • 48

    YatesPD,,·杰克勒)RK,,SatarB,,PittsLH,&OghalaiJS:Is it worthwhile to attempt hearing preservation in larger acoustic neuromas?.Otol Neurotol24:460464,2003

    • Search Google Scholar
    • Export Citation
  • 49

    YokohA,,KobayashiS,,TanakaY,,GiboH,&SugitaK:Preservation of cochlear nerve function in acoustic neurinoma surgery.Acta Neurochir (Wien)123:813,1993

    • Search Google Scholar
    • Export Citation
  • 50

    YongRL,,WesterbergBD,,DongC,&AkagamiR:Length of tumor-cochlear nerve contact and hearing outcome after surgery for vestibular schwannoma.J Neurosurg108:105110,2008

    • Search Google Scholar
    • Export Citation

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