Ipsilateral cochlear implantation in cases with vestibular schwannoma

Abstract

Background: Vestibular schwannomas (VS) are the most common tumors in the cerebellopontine angle, which can lead to hearing loss, particularly following tumor resection. For patients with bilateral VS associated with neurofibromatosis type 2 (NF2), hearing loss significantly undermines their quality of life.

Objective: This study aims to evaluate the outcomes of ipsilateral cochlear implantation (CI) in patients with VS.

Method: We assessed six patients with VS, three of whom were diagnosed with NF2. Four patients underwent VS resection combined with simultaneous ipsilateral CI. Two patients received CI without tumor removal. Electrically evoked auditory brainstem response (eABR) testing was employed to assess the functionality of the cochlear nerve during the resection procedure.

Results: Simultaneous ipsilateral CI following VS resection was performed in four patients who underwent tumor removal, and cochlear nerve function was identified using eABR testing. Two patients without tumor resection also had implantations. The average impedance of the test electrodes was within the normal range and neural telemetry responses were detected in all patients. One patient opted out of using the cochlear due to normal hearing in the contralateral ear and found the implant unbeneficial. The remaining five patients experienced improvements in hearing, albeit to varying degrees.

Conclusion: Simultaneous ipsilateral CI after VS resection is an effective approach for auditory rehabilitation. For NF2 patients with small, stable tumors, CI without tumor removal can also be considered a viable option. This study highlights the potential of CI in hearing rehabilitation for patients with VS, particularly those with NF2.

Keywords

cochlear implantation / hearing rehabilitation / vestibular schwannoma

References

[1] Reznitsky M , Petersen M , West N , Stangerup SE , Cayé-Thomasen P . Epidemiology of vestibular schwannomas-prospective 40-year data from an unselected national cohort. Clin Epidemiol. 2019; 11: 981- 986.

[2] Fernández-Méndez R , Wan Y , Axon P , Joannides A . Incidence and presentation of vestibular schwannoma: a 3-year cohort registry study. Acta Neurochir. 2023; 165 (10): 2903- 2911.

[3] Kleijwegt M , Ho V , Visser O , Godefroy W , van der Mey A . Real incidence of vestibular schwannoma? Estimations from a national registry. Otol Neurotol. 2016; 37 (9): 1411- 1417.

[4] Koo M , Lai JT , Yang EY , Liu TC , Hwang JH . Incidence of vestibular schwannoma in Taiwan from 2001 to 2012: a population-based National Health Insurance study. Ann Otol Rhinol Laryngol. 2018; 127 (10): 694- 697.

[5] Marinelli JP , Beeler CJ , Carlson ML , Caye-Thomasen P , Spear SA , Erbele ID . Global incidence of sporadic vestibular schwannoma: a systematic review. Otolaryngol Head Neck Surg. 2022; 167 (2): 209- 214.

[6] Marinelli JP , Lohse CM , Carlson ML . Incidence of vestibular schwannoma over the past half-century: a population-based study of Olmsted County, Minnesota. Otolaryngol Head Neck Surg. 2018; 159 (4): 717- 723.

[7] Goldbrunner R , Weller M , Regis J . EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 2020; 22 (1): 31- 45.

[8] Carlson ML , Vivas EX , Mccracken DJ . Congress of neurological surgeons systematic review and evidence-based guidelines on hearing preservation outcomes in patients with sporadic vestibular schwannomas. Neurosurgery. 2018; 82 (2): E35- E39.

[9] Hoffman RA , Kohan D , Cohen NL . Cochlear implants in the management of bilateral acoustic neuromas. Am J Otol. 1992; 13 (6): 525- 528.

[10] Arriaga MMA , Marks CS . Simultaneous cochlear implantation and acoustic neuroma resection-imaging considerations, technique, and functional outcome. Otolaryngol Head Neck Surg. 1995; 112 (2): 325- 328.

[11] Doyle EJ III , Samy RN . Cochlear implantation: an effective modality for hearing restoration following vestibular schwannoma resection. Curr Opin Otolaryngol Head Neck Surg. 2022; 30 (5): 309- 313.

[12] Jia H , EL Sayed MME , Smail M . Neurofibromatosis type 2: hearing preservation and rehabilitation. Neurochirurgie. 2018; 64 (5): 348- 354.

[13] Lassaletta L , Calvino M , Diaz M . Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: lessons learned. Hear Res. 2024; 446: 108997.

[14] Gadenstaetter AJ , Auinger AB , Gerlitz M . Functional outcome after simultaneous vestibular schwannoma resection and cochlear implantation with intraoperative cochlear nerve monitoring. Otolaryngol Head Neck Surg. 2023; 168 (6): 1502- 1510.

[15] Sanna M , Piccirillo E , Kihlgren C , Cagliero G , Guidi M , Saleh E . Simultaneous cochlear implantation after translabyrinthine vestibular schwannoma resection: a report of 41 cases. Otol Neurotol. 2021; 42 (9): 1414- 1421.

[16] Doerfer KW , Fritz CG , Porps SL , Hong RS , Jacob JT , Babu SC . Twelve-month outcomes of simultaneous translabyrinthine resection and cochlear implantation. Otolaryngol Head Neck Surg. 2023; 169 (2): 358- 366.

[17] West N , Sass H , Caye-Thomasen P . Sporadic and NF2-associated vestibular schwannoma surgery and simultaneous cochlear implantation: a comparative systematic review. Eur Arch Otorhinolaryngol. 2020; 277 (2): 333- 342.

[18] Salem N , Galal A , Mastronardi V , Talaat M , Sobhy O , Sanna M . Audiological evaluation of vestibular schwannoma patients with normal hearing. Audiol Neurootol. 2019; 24 (3): 117- 126.

[19] Brackmann DE , Owens RM , Friedman RA . Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol. 2000; 21 (3): 417- 424.

[20] Neff BA , Wiet RM , Lasak JM . Cochlear implantation in the neurofibromatosis type 2 patient: long-term follow-up. Laryngoscope. 2007; 117 (6): 1069- 1072.

[21] Graham J , Lynch C , Weber B , Stollwerck L , Wei J , Brookes G . The magnetless Clarion® cochlear implant in a patient with neurofibromatosis 2. J Laryngol Otol. 1999; 113 (5): 458- 463.

[22] Vincenti V , Pasanisi E , Guida M , Di Trapani G , Sanna M . Hearing rehabilitation in neurofibromatosis type 2 patients: cochlear versus auditory brainstem implantation. Audiol Neuro Otol. 2008; 13 (4): 273- 280.

[23] Fiasca VMDP , Tealdo G . Intraoperative cochlear nerve monitoring in cochlear implantation after vestibular schwannoma resection. Audiol Res. 2023; 13 (3): 398- 407.

[24] Itamura K , Geerardyn A , Podury A . Cochlear ossification after vestibular schwannoma surgery: a temporal bone study. Otolaryngol Head Neck Surg. 2023; 169 (2): 333- 339.

[25] Van Waegeningh HF , Loos E , Van Havenbergh T , Somers T . Cochlear patency after translabyrinthine and retrosigmoid vestibular schwannoma surgery. J Int Adv Otol. 2020; 16 (1): 53- 57.

[26] Huang Y-C , Hsu SPC , Chiang K-W , Wang MC . Cochlear obliteration after translabyrinthine resection for large cerebellopontine angle tumor. Audiol Neuro Otol. 2023; 28 (1): 63- 74.

[27] Carswell V , Crowther JA , Locke R , Taylor W , Kontorinis G . Cochlear patency following translabyrinthine vestibular schwannoma resection: implications for hearing rehabilitation. J Laryngol Otol. 2019; 133 (7): 560- 565.

[28] Delgado-Vargas B , Medina M , Polo R . Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation. Acta Otorhinolaryngol Ital. 2018; 38 (1): 56- 60.

[29] Schwartz N , Rooth MA , Dillon MT . MRI surveillance following concurrent cochlear implantation in cases of vestibular schwannoma resection. Am J Otolaryngol. 2020; 41 (4): 102518.

[30] Crane BT , Gottschalk B , Kraut M , Aygun N , Niparko JK . Magnetic resonance imaging at 1.5 T after cochlear implantation. Otol Neurotol. 2010; 31 (8): 1215- 1220.

[31] Carlson ML , Neff BA , Link MJ . Magnetic resonance imaging with cochlear implant magnet in place: safety and imaging quality. Otol Neurotol. 2015; 36 (6): 965- 971.

[32] Hassepass F , Arndt S , Aschendorff A , Laszig R , Wesarg T . Cochlear implantation for hearing rehabilitation in single-sided deafness after translabyrinthine vestibular schwannoma surgery. Eur Arch Otorhinolaryngol. 2016; 273 (9): 2373- 2383.

[33] Klenzner T , Glaas M , Volpert S , Jansen N , Kristin J , Schipper J . Cochlear implantation in patients with single-sided deafness after the translabyrinthine resection of the vestibular schwannomaPresented at the Annual Meeting of ADANO 2016 in Berlin. Otol Neurotol. 2019; 40 (4): E461- E466.

[34] DI Micco R , Salcher R , Lesinski-Schiedat A . Long-term hearing outcome of cochlear implantation in cases with simultaneous intracochlear schwannoma resection. Laryngoscope. 2024; 134 (4): 1854- 1860.

[35] Nowak A , Dziedzic T , Czernicki T . Strategy for the surgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2. Neurol Neurochir Pol. 2015; 49 (5): 295- 301.

[36] Carlson ML , Breen JT , Driscoll CL . Cochlear implantation in patients with neurofibromatosis type 2: variables affecting auditory performance. Otol Neurotol. 2012; 33 (5): 853- 862.

[37] Dirks MS , Butman JA , Kim HJ . Long-term natural history of neurofibromatosis type 2-associated intracranial tumors. J Neurosurg. 2012; 117 (1): 109- 117.

[38] Ito E , Saito K , Yatsuya H , Nagatani T , Otsuka G . Factors predicting growth of vestibular schwannoma in neurofibromatosis type 2. Neurosurg Rev. 2009; 32 (4): 425- 433.

RIGHTS & PERMISSIONS

The Author(s). Eye & ENT Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.