Partial Hearing Preservation after Translabyrinthine Vestibular Schwannoma Resection: Case Report and Review of the Literature

Abstract

Objectives To describe a unique case report of a patient who had partial hearing preservation after translabyrinthine (TL) removal of a vestibular schwannoma (VS).

Study Design Case report.

Methods The patient's chart was reviewed for hearing levels before and after surgery. Preoperative magnetic resonance imaging (MRI) was compared with postoperative MRI for determination of completeness of tumor removal. The literature on hearing preservation after TL resection is reviewed.

Results A 42-year-old woman underwent a TL removal of a VS. The patient's preoperative pure tone average (PTA) was 70 dB and word recognition score (WRS) was 40%. Postoperatively, the patient was able to hear ambient noise in the surgical ear. Her bone conduction PTA was 70 dB, but the WRS score dropped to 2%. One year later, she continues to hear ambient noise and sound in the operative ear.

Discussion This is the fifth reported case of partial hearing preservation after TL VS resection. It suggests that by preserving the vestibule and the fluids within the vestibule when possible, there maybe enough residual auditory neural structures for a traditional cochlear implant to benefit such a patient. In addition, preserving the incus when possible may help maintain air conduction to help patients with sound localization.

Keywords

translabyrinthine vestibular schwannoma resection - vestibule - hearing preservation - translabyrinthine resection

• References

• 1 Shelton C, Brackmann DE, House WF, Hitselberger WE. Middle fossa acoustic tumor surgery: results in 106 cases. Laryngoscope 1989; 99 (4) 405-408
• 2 Arriaga MA, Chen DA. Facial function in hearing preservation acoustic neuroma surgery. Arch Otolaryngol Head Neck Surg 2001; 127 (5) 543-546
• 3 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997; 40 (2) 248-260 ; discussion 260–262
• 4 McElveen Jr JT, Wilkins RH, Erwin AC, Wolford RD. Modifying the translabyrinthine approach to preserve hearing during acoustic tumour surgery. J Laryngol Otol 1991; 105 (1) 34-37
• 5 Smith PG, Bigelow DC, Kletzker GR, Leonetti JP, Pugh BK, Mishler ET. Hearing preservation following a transtemporal resection of an acoustic schwannoma: a case report. Am J Otol 1993; 14 (5) 434-436
• 6 Rizvi SS, Goyal RN. Case report and discussion of hearing preservation after translabyrinthine excision of small acoustic tumors. Am J Otol 1999; 20 (2) 249-252
• 7 Springborg LK, Springborg JB, Thomsen J. Hearing preservation after classical translabyrinthine removal of a vestibular schwannoma: case report and literature review. J Laryngol Otol 2007; 121 (1) 76-79
• 8 Tringali S, Ferber-Viart C, Gallégo S, Dubreuil C. Hearing preservation after translabyrinthine approach performed to remove a large vestibular schwannoma. Eur Arch Otorhinolaryngol 2009; 266 (1) 147-150
• 9 Kristensen HK. Acoustic-vestibular and histologic examinations in guinea-pigs after interruption of membranous labyrinth in semicircular canals or cochlea. Acta Otolaryngol 1960; 51: 382-402
• 10 Lempert J, Meltzer PE, Rambo JH, Wever E. The effects of injury to the lateral semicircular canals. Trans Am Acad Ophthalmol Otolaryngol 1956; 60 (5) 718-727
• 11 Smouha EE, Inouye M. Partial labyrinthectomy with hearing preservation: frequency-specific data using tone-burst auditory brain stem response. Otolaryngol Head Neck Surg 1999; 120 (2) 146-152
• 12 Canalis RF, Gussen R, Abemayor E, Andrews J. Surgical trauma to the lateral semicircular canal with preservation of hearing. Laryngoscope 1987; 97 (5) 575-581
• 13 Jahrsdoerfer RA, Johns ME, Cantrell RW. Labyrinthine trauma during ear surgery. Laryngoscope 1978; 88 (10) 1589-1595
• 14 Bumsted RM, Dolan KD, Sadé J, McCabe BF. Preservation of cochlear function after extensive labyrinthine destruction. Ann Otol Rhinol Laryngol 1977; 86 (2 pt. 1) 131-137
• 15 Schuknecht HF, Woellner RC. An experimental and clinical study of deafness from lesions of the cochlear nerve. J Laryngol Otol 1955; 69 (2) 75-97
• 16 Ahsan S, Telischi F, Hodges A, Balkany T. Cochlear implantation concurrent with translabyrinthine acoustic neuroma resection. Laryngoscope 2003; 113 (3) 472-474
• 17 Magliulo G, Parrotto D, Stasolla A, Marini M. Modified translabyrinthine approach and hearing preservation. Laryngoscope 2004; 114 (6) 1133-1138