Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a “Test Intracochlear Electrode”

 

 Permissions and Reprints

Abstract

Objectives A decision on whether to insert a cochlear implant can be made in neurofibromatosis 2 (NF2) if there is objective evidence of cochlear nerve (CN) function post vestibular schwannoma (VS) excision. We aimed to develop intraoperative CN monitoring to help in this decision.

Design We describe the intraoperative monitoring of a patient with NF2 and our stimulating and recording set up. A novel test electrode is used to stimulate the CN electrically.

Setting This study was set at a tertiary referral center for skull base pathology.

Main outcome measure Preserved auditory brainstem responses leading to cochlear implantation.

Results Electrical auditory brainstem response (EABR) waveforms will be displayed from different stages of the operation. A cochlear implant was inserted at the same sitting based on the EABR.

Conclusion Electrically evoked CN monitoring can provide objective evidence of CN function after VS excision and aid in the decision-making process of hearing rehabilitation in patients who will be rendered deaf.

• References

• 1 Neary WJ, Hillier VF, Flute T, Stephens D, Ramsden RT, Evans DG. Use of a closed set questionnaire to measure primary and secondary effects of neurofibromatosis type 2. J Laryngol Otol 2010; 124 (07) 720-728
  CrossrefPubMedGoogle Scholar
• 2 Cueva RA, Thedinger BA, Harris JP, Glasscock III ME. Electrical promontory stimulation in patients with intact cochlear nerve and anacusis following acoustic neuroma surgery. Laryngoscope 1992; 102 (11) 1220-1224
  CrossrefPubMedGoogle Scholar
• 3 Arriaga MA, Marks S. Simultaneous cochlear implantation and acoustic neuroma resection: imaging considerations, technique, and functional outcome. Otolaryngol Head Neck Surg 1995; 112 (02) 325-328
  CrossrefPubMedGoogle Scholar
• 4 Colletti V, Fiorino FG, Carner M, Cumer G, Giarbini N, Sacchetto L. Intraoperative monitoring for hearing preservation and restoration in acoustic neuroma surgery. Skull Base Surg 2000; 10 (04) 187-195
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Arístegui M, Denia A. Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of two cases (neurofibromatosis type 2 and unilateral vestibular schwannoma). Otol Neurotol 2005; 26 (02) 205-210
  CrossrefPubMedGoogle Scholar
• 6 Lloyd SK, Glynn FJ, Rutherford SA. , et al. Ipsilateral cochlear implantation after cochlear nerve preserving vestibular schwannoma surgery in patients with neurofibromatosis type 2. Otol Neurotol 2014; 35 (01) 43-51
  CrossrefPubMedGoogle Scholar
• 7 Vincenti V, Pasanisi E, Guida M, Di Trapani G, Sanna M. Hearing rehabilitation in neurofibromatosis type 2 patients: cochlear versus auditory brainstem implantation. Audiol Neurootol 2008; 13 (04) 273-280
  CrossrefPubMedGoogle Scholar
• 8 Belal A. Is cochlear implantation possible after acoustic tumor removal?. Otol Neurotol 2001; 22 (04) 497-500
  CrossrefPubMedGoogle Scholar
• 9 Youssef AS, Downes AE. Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus 2009; 27 (04) E9
  PubMedGoogle Scholar
• 10 Cueva RA, Morris GF, Prioleau GR. Direct cochlear nerve monitoring: first report on a new atraumatic, self-retaining electrode. Am J Otol 1998; 19 (02) 202-207
  PubMedGoogle Scholar
• 11 Yingling CD, Gardi JN. Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. Otolaryngol Clin North Am 1992; 25 (02) 413-448
  CrossrefPubMedGoogle Scholar
• 12 Polak M, Eshraghi AA, Nehme O. , et al. Evaluation of hearing and auditory nerve function by combining ABR, DPOAE and eABR tests into a single recording session. J Neurosci Methods 2004; 134 (02) 141-149
  CrossrefPubMedGoogle Scholar
• 13 Jannetta PJ, Møller AR, Møller MB. Technique of hearing preservation in small acoustic neuromas. Ann Surg 1984; 200 (04) 513-523
  CrossrefPubMedGoogle Scholar
• 14 Moller AR. Intraoperative Neurophysiological Monitoring. 2nd ed. Totowa, NJ: Humana Press; 2006
  Google Scholar
• 15 Battista RA, Wiet RJ, Paauwe L. Evaluation of three intraoperative auditory monitoring techniques in acoustic neuroma surgery. Am J Otol 2000; 21 (02) 244-248
  CrossrefPubMedGoogle Scholar
• 16 Martin WH, Stecker MM. ASNM position statement: intraoperative monitoring of auditory evoked potentials. J Clin Monit Comput 2008; 22 (01) 75-85
  CrossrefPubMedGoogle Scholar
• 17 Oh T, Nagasawa DT, Fong BM. , et al. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas. Neurosurg Focus 2012; 33 (03) E6
  CrossrefPubMedGoogle Scholar
• 18 Radtke RA, Erwin CW. Intraoperative monitoring of auditory and brain-stem function. Neurol Clin 1988; 6 (04) 899-915
  CrossrefPubMedGoogle Scholar
• 19 Watanabe E, Schramm J, Strauss C, Fahlbusch R. Neurophysiologic monitoring in posterior fossa surgery. II. BAEP-waves I and V and preservation of hearing. Acta Neurochir (Wien) 1989; 98 (3-4): 118-128
  CrossrefPubMedGoogle Scholar
• 20 James ML, Husain AM. Brainstem auditory evoked potential monitoring: when is change in wave V significant?. Neurology 2005; 65 (10) 1551-1555
  CrossrefPubMedGoogle Scholar
• 21 Nadol Jr JB, Chiong CM, Ojemann RG. , et al. Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope 1992; 102 (10) 1153-1158
  CrossrefPubMedGoogle Scholar
• 22 Sugiyama K, Yokoyama T, Ryu H, Uemura K, Miyamoto T, Shimoyama I. Intra-operative monitoring with ABR during neurovascular decompression for VIIth and VIIIth cranial nerves: a warning sign for surgeons [in Japanese]. No Shinkei Geka 1989; 17 (06) 545-553
  PubMedGoogle Scholar
• 23 AAO-HNS. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
  CrossrefPubMedGoogle Scholar
• 24 Markand ON, Warren C, Mallik GS, Williams CJ. Temperature-dependent hysteresis in somatosensory and auditory evoked potentials. Electroencephalogr Clin Neurophysiol 1990; 77 (06) 425-435
  CrossrefPubMedGoogle Scholar
• 25 Rodriguez RA, Audenaert SM, Austin III EH, Edmonds Jr HL. Auditory evoked responses in children during hypothermic cardiopulmonary bypass: report of cases. J Clin Neurophysiol 1995; 12 (02) 168-176
  CrossrefPubMedGoogle Scholar
• 26 Simon MV. Neurophysiologic intraoperative monitoring of the vestibulocochlear nerve. J Clin Neurophysiol 2011; 28 (06) 566-581
  CrossrefPubMedGoogle Scholar
• 27 Miyamoto RT, Brown DD. Electrically evoked brainstem responses in cochlear implant recipients. Otolaryngol Head Neck Surg 1987; 96 (01) 34-38
  CrossrefPubMedGoogle Scholar
• 28 Legatt AD. Mechanisms of intraoperative brainstem auditory evoked potential changes. J Clin Neurophysiol 2002; 19 (05) 396-408
  CrossrefPubMedGoogle Scholar
• 29 Gouveris H, Mann W. Association between surgical steps and intraoperative auditory brainstem response and electrocochleography waveforms during hearing preservation vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 2009; 266 (02) 225-229
  CrossrefPubMedGoogle Scholar
• 30 Sekiya T, Møller AR. Avulsion rupture of the internal auditory artery during operations in the cerebellopontine angle: a study in monkeys. Neurosurgery 1987; 21 (05) 631-637
  CrossrefPubMedGoogle Scholar
• 31 Evans DG, Baser ME, O'Reilly B. , et al. Management of the patient and family with neurofibromatosis 2: a consensus conference statement. Br J Neurosurg 2005; 19 (01) 5-12
  CrossrefPubMedGoogle Scholar
• 32 Nishihara K, Hanakita J, Kinuta Y, Kondo A, Yamamoto Y, Nakatani H. Importance of intraoperative monitoring of ABR and compound action potential of the eighth cranial nerve during microvascular decompression surgery [in Japanese]. No Shinkei Geka 1986; 14 (04) 509-518
  PubMedGoogle Scholar
• 33 Nadol Jr JB, Levine R, Ojemann RG, Martuza RL, Montgomery WW, de Sandoval PK. Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle. Laryngoscope 1987; 97 (11) 1287-1294
  CrossrefPubMedGoogle Scholar
• 34 Rudzinski P, Wegrzyn P, Lis GJ. , et al. Vasodilatory effect and endothelial integrity in papaverine- and milrinone-treated human radial arteries. J Physiol Pharmacol 2013; 64 (01) 41-45
  PubMedGoogle Scholar
• 35 Filipo R, Attanasio G, Russo FY. , et al. Oral versus short-term intratympanic prednisolone therapy for idiopathic sudden hearing loss. Audiol Neurootol 2014; 19 (04) 225-233
  CrossrefPubMedGoogle Scholar
• 36 Sekiya T, Shimamura N, Suzuki S, Hatayama T. Methylprednisolone ameliorates cochlear nerve degeneration following mechanical injury. Hear Res 2001; 151 (1-2): 125-132
  CrossrefPubMedGoogle Scholar
• 37 Strauss C, Bischoff B, Neu M, Berg M, Fahlbusch R, Romstöck J. Vasoactive treatment for hearing preservation in acoustic neuroma surgery. J Neurosurg 2001; 95 (05) 771-777
  CrossrefPubMedGoogle Scholar
• 38 Gouveris H, Mewes T, Maurer J, Mann W. Steroid and vasoactive treatment for acute deafness after attempted hearing preservation acoustic neuroma surgery. ORL J Otorhinolaryngol Relat Spec 2005; 67 (01) 30-33
  CrossrefPubMedGoogle Scholar
• 39 Bischoff B, Romstöck J, Fahlbusch R, Buchfelder M, Strauss C. Intraoperative brainstem auditory evoked potential pattern and perioperative vasoactive treatment for hearing preservation in vestibular schwannoma surgery. J Neurol Neurosurg Psychiatry 2008; 79 (02) 170-175
  CrossrefPubMedGoogle Scholar
• 40 Scheller C, Richter HP, Engelhardt M, Köenig R, Antoniadis G. The influence of prophylactic vasoactive treatment on cochlear and facial nerve functions after vestibular schwannoma surgery: a prospective and open-label randomized pilot study. Neurosurgery 2007; 61 (01) 92-97 , discussion 97–98
  CrossrefPubMedGoogle Scholar