Yonsei Med J.  2016 Nov;57(6):1535-1539. 10.3349/ymj.2016.57.6.1535.

Simultaneous Translabyrinthine Tumor Removal and Cochlear Implantation in Vestibular Schwannoma Patients

• Kim JW
• Han JH
• Kim JW
• Moon IS

• KMID: 2427178
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1535

Abstract

Refinement of surgical techniques has allowed hearing preservation after tumor resection to be prioritized. Moreover, restoration of hearing after tumor removal can be attempted in patients with bilateral vestibular schwannomas or those with a schwannoma in the only-hearing ear. Cochlear implantation (CI) has emerged as a proper method of acoustic rehabilitation, provided that the cochlear nerve remains intact. Studies of electrical promontory stimulation in patients after vestibular schwannoma resection have demonstrated favorable results. We describe herein two cases of hearing rehabilitation via CI implemented at the time of vestibular schwannoma resection. Tumors were totally removed, and cochlear implant electrodes were successfully inserted in both cases. Also, post operative CI-aided hearing showed improved results.

Keyword

Vestibular schwannoma; cochlear implantation; translabyrinthine approach

MeSH Terms

Aged
Cochlear Implantation/*methods
Cochlear Nerve/pathology/surgery
Female
Hearing Loss, Sensorineural/etiology/physiopathology/rehabilitation/surgery
Humans
Male
Middle Aged
Neurofibromatosis 2/diagnosis/*surgery
Neuroma, Acoustic/complications/diagnosis/*surgery
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 (A) Preoperative pure tone audiogram revealed moderate sensorineural hearing loss on the right and severe mixed hearing loss on the left. (B) Postoperative aided hearing threshold. Right ear was aided by hearing aid, and left ear was aided by CI. (C) The right side was aided by hearing aid and the left side by cochlear implant. Low signal on T2 and high signal enhanced T1 (D) indicate that the tumor (arrow) is a schwannoma. (E) The tumor (arrow) was totally removed via a translabyrinthine approach. The cochlear nerve was anatomically preserved during the operation. (F) Cochlear implantation was performed simultaneously. The internal device electrode was inserted through a posterior tympanotomy site (arrow). To prevent cerebrospinal fluid leakage, the tympanotomy site was plugged with a small piece of temporalis muscle after implantation.

• 

  Fig. 2 (A) Preoperative pure tone audiogram revealed bilateral sensorineural hearing loss. The right side showed moderate and the left side showed profound hearing loss. (B) Postoperative bimodal aided hearing threshold. Right side was aided by hearing aid and left side was aided by CI. (C) Low signal on T2 image and high signal on gadolinium-enhanced T1 (D) indicate that the tumor (arrow) has a high possibility of schwannoma. (E) The tumor (T) was separated and dissected from CN VIII (white arrow). (F) After tumor removal via a translabyrinthine approach, a well-preserved cochleo-vestibular nerve (arrow) and intact facial nerve (white arrowhead) were noted. (G) After repair of the dura with abdominal fat, the round window of the cochlea (arrowhead) was identified. (H) Cochlear implantation was performed simultaneously. The internal device electrode (arrow) was inserted through the round window.

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