Search Results (7)

Preservation of function is an important goal during surgical management of cochleovestibular schwannomas. We here demonstrate the relief of vertigo and the preservation of function of all five vestibular receptors after removal of an intracochlear schwannoma with extension to the fundus of the internal auditory canal. A 61-year-old male with a five-year history of left-sided deafness, tinnitus, vertigo attacks, and an MRI consistent with an intracochlear schwannoma with limited extension through the modiolus to the fundus of the internal auditory canal (IAC) underwent transcanal, transcochlear total tumor removal and—due to a cerebrospinal fluid leak from the fundus of the IAC—revision surgery with lateral petrosectomy and blind sac closure of the external auditory canal. Despite complete removal of the cochlear partition of the inner ear (total cochlectomy), the patient’s vestibular receptors remained functional, and the vertigo symptoms disappeared. These results show that vestibular labyrinthine function may not only be preserved after partial or subtotal cochlectomy but also after complete cochlear removal. This further confirms the vestibular labyrinth’s robustness and encourages surgical management of transmodiolar schwannomas with limited extension to the fundus of the IAC. Full article

Background: In most cases, intralabyrinthine schwannoma (ILS) occurs in patients with unilateral hearing deterioration or neurofibromatosis type II (NF II). The pattern of localization of these tumors varies but mostly affects the cochlea. Extirpation of the cochlear schwannoma, if hidden by the cochlea modiolus, is difficult under the aspect of complete removal. Therefore, a tissue removal device (TRD) was designed and tested in temporal bones. The principle of handling the new device is a pushing and pipe cleaner handling inside the cochlea. This present study aimed to describe the first in vivo experience with the newly developed TRD for removing cochlear intralabyrinthine schwannomas. Methods: In three patients, the TRD was used for the tumor removal of cochlear schwannomas. In two patients with a cochlear schwannoma in combination with a cochlea implantation and one patient suffering from NF II, a cochlear schwannoma was removed with the TRD. The access was performed with a posterior tympanotomy, an enlarged round window approach and an additional second turn access. The device was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. By pushing and pipe cleaner handling, the tumors were removed. An MRI control was performed on the day postoperatively with a T1 GAD sequence. Results: Tumor removal with the TRD was performed in a 15-min procedure without any complications. An MRI control confirmed complete removal on the postoperative day in all cases. Conclusions: In vivo handling of the device confirmed straightforward handling for the tumor removal. MRI scanning showed complete removal of the tumor by the TRD. Full article

Objectives: Simultaneous removal and cochlear implantation (CI) have been reported in intralabyrinthine and intracochlear schwannoma. A wide range of postoperative hearing outcomes have been reported after CI in these cases. This study evaluated the outcomes of performing a simultaneous resection of Schwannoma in cochlea and cochlear implantation (CI), aiming to assess the effectiveness of this combined surgical approach for hearing rehabilitation with CI. Methods: This retrospective case series was conducted at a tertiary care center. The study included four consecutive patients with profound sensorineural hearing loss due to a mass inside the cochlea. These patients underwent simultaneous single-sided CI and tumor resection performed by the same surgeon. Preoperative and postoperative audiological assessments were conducted to evaluate the patients’ hearing outcomes before and after the surgical intervention. Results: Simultaneous CI with tumor resection was successful in all cases. Two of the four patients had a unilateral tumor, while the other two had a bilateral tumor with the involvement of the internal auditory canal and cerebellopontine angle (neurofibromatosis type 2 (NF2)). In two cases of unilateral tumor, aided free-field pure tone average (PTA) was 26 dB, and 46 dB hearing level (HL), and word recognition score (WRS) at 65 dB was 40% and 68%, respectively, 3 months after surgery. In two cases of tumor with NF2, aided free-field PTA was 36 dB and 60 dB HL, and both cases showed 0% WRS at 65 dB 3 months after surgery. Conclusions: Simultaneous schwannoma excision and CI in patients with Schwannoma inside cochlea are surgically practical and safe. Postoperatively, there was a notable improvement in hearing in cases of sporadic schwannoma, regardless of the type of CI used. However, there was 0% WRS in the two NF2 patients with a mass in the internal auditory canal. Full article

Background: The use of a cochlear implant (CI) for hearing rehabilitation after vestibular schwannoma (VS) resection is widely spreading. The procedure is usually performed simultaneously to tumor resection with a translabyrinthine approach. To ensure the best device function, assessing the integrity of the cochlear nerve is of primary importance. Methods: A narrative review of the literature on the present topic was carried out up to June 2022. Finally, nine studies were considered. Results: Electrically evoked auditory brainstem responses (eABR) is the most widely used method of intraoperative monitoring of cochlear nerve (CN) during VS resection, although its limits are known. It can be assessed through the CI electrode array or through an intracochlear test electrode (ITE). Variations of the graph are evaluated during the surgical procedure, in particular the wave V amplitude and latency. As tumor dissection progresses, the parameters may change, informing of the CN status, and the surgical procedure may be modulated. Conclusion: An eABR positive result seems to be reliably correlated with a good CI outcome in those cases in which a clear wave V is recorded before and after tumor removal. On the contrary, in those cases in which the eABR is lost or altered during the surgical procedure, the positioning of a CI is still debatable. Full article

Intralabyrinthine schwannomas (ILS) are rare benign tumours arising from the peripheral branches of the cochlear or vestibular nerves in the membranous labyrinth, intracochlear schwannomas being the most frequent ones. When hearing is no longer feasible on the affected side, surgical removal along with simultaneous cochlear implantation can be proposed to the patient. We hereby present a systematic review of the literature on the topic, as well as two original cases from our centre (Ospedale Università degli Studi di Padova). Cochlear implantation in intracochlear schwannomas is feasible, with overall satisfactory hearing outcomes in accordance with the evidence found in the literature. Full article

Background: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. Methods: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. Results: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. Conclusion: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion. Full article

Intralabyrinthine schwannoma (ILS) is a rare benign tumor of the inner ear potentially causing unilateral sensorineural hearing loss and vertigo. This study evaluated the outcome of one surgical session comprising microsurgical ILS resection and cochlear implantation in terms of surgical feasibility, complications, and auditory outcome. Ten clinically and histologically confirmed ILS patients included in this study (three women and seven men; mean age 56.4 ± 8.6) underwent surgery between July 2015 and February 2020. Eight patients had intracochlear tumor location; the remaining two had vestibulocochlear and intravestibular ILS. One of the three following methods was used for tumor removal: an extended cochleostomy, subtotal cochleoectomy, or a translabyrinthine approach. Although negligible improvement was observed in two of the patients, two patients were lost to follow-up, and one opted out from using CI, the speech perception of the five remaining ILS patients improved as per the Freiburg Monosyllable Test (FMT) from 0% before surgery to 45– 50% after the implantation. Our study supports the presented surgical approach’s feasibility and safety, enabling tumor removal and hearing restoration shortly after surgery. Full article