Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

Abstract

Introduction Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing.

Objective This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation.

Data Synthesis The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochlea measuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochlea was anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB.

Conclusion Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

Keywords

cochlea - intracochlear schwannoma - hearing loss - hearing rehabilitation - cochlear implantation

• References

• 1 Bento RF. Tratado de Implante Coclear e Próteses Auditivas Implantáveis. 1st ed. Rio de Janeiro, Brazil: Thieme Publicações Ltda; 2014
• 2 von Ilberg C, Kiefer J, Tillein J , et al. Electric-acoustic stimulation of the auditory system. New technology for severe hearing loss. ORL J Otorhinolaryngol Relat Spec 1999; 61 (6) 334-340
• 3 Skarzyński H, Lorens A, D'Haese P , et al. Preservation of residual hearing in children and post-lingually deafened adults after cochlear implantation: an initial study. ORL J Otorhinolaryngol Relat Spec 2002; 64 (4) 247-253
• 4 Bento RF, Brito Neto R, Castilho AM , et al. Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Braz J Otorhinolaryngol 2004; 70: 632-637
• 5 Kiefer J, Pok M, Adunka O , et al. Combined electric and acoustic stimulation of the auditory system: results of a clinical study. Audiol Neurootol 2005; 10 (3) 134-144
• 6 Salzman KL, Childs AM, Davidson HC, Kennedy RJ, Shelton C, Harnsberger HR. Intralabyrinthine schwannomas: imaging diagnosis and classification. AJNR Am J Neuroradiol 2012; 33 (1) 104-109
• 7 Miller ME, Moriarty JM, Linetsky M, Lai C, Ishiyama A. Intracochlear schwannoma presenting as diffuse cochlear enhancement: diagnostic challenges of a rare cause of deafness. Ir J Med Sci 2012; 181 (1) 131-134
• 8 Jiang ZY, Kutz Jr JW, Roland PS, Isaacson B. Intracochlear schwannomas confined to the otic capsule. Otol Neurotol 2011; 32 (7) 1175-1179
• 9 Kronenberg J, Horowitz Z, Hildesheimer M. Intracochlear schwannoma and cochlear implantation. Ann Otol Rhinol Laryngol 1999; 108 (7 Pt 1): 659-660
• 10 Neff BA, Willcox Jr TO, Sataloff RT. Intralabyrinthine schwannomas. Otol Neurotol 2003; 24 (2) 299-307
• 11 Magliulo G, Colicchio G, Romana AF, Stasolla A. Intracochlear schwannoma. Skull Base 2010; 20 (2) 115-118
• 12 Green Jr JD, McKenzie JD. Diagnosis and management of intralabyrinthine schwannomas. Laryngoscope 1999; 109 (10) 1626-1631
• 13 Kennedy RJ, Shelton C, Salzman KL, Davidson HC, Harnsberger HR. Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol 2004; 25 (2) 160-167