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Delayed hearing loss after microvascular decompression for hemifacial spasm

  • Original Article - Functional Neurosurgery - Other
  • Published:
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Abstract

Background

This study aimed to analyze cases of delayed hearing loss after microvascular decompression (MVD) for hemifacial spasm and identify the characteristic features of these patients.

Methods

We retrospectively reviewed the medical records of 3462 patients who underwent MVD for hemifacial spasm between January 1998 and August 2017.

Results

Among these, there were 5 cases in which hearing was normal immediately postoperatively but delayed hearing loss occurred. None of the 5 patients reported any hearing disturbance immediately after the operation. However, they developed hearing problems suddenly after some time (median, 22 days; range 10–45 days). On examination, sensorineural hearing loss was confirmed. High-dose corticosteroid treatment was prescribed. Preoperative hearing levels were restored after several months (median duration from the time of the operation, 45 days; range 22–118 days). Interestingly, the inter-peak latency of waves I–III in the brainstem auditory evoked potential (BAEP) was prolonged during the surgery, but recovered within a short time.

Conclusion

Delayed hearing loss may occur after MVD for HFS. Prolongation of the inter-peak latency of waves I–III seems to be associated with the occurrence of delayed hearing loss. It is possible that BAEP changes may predict delayed hearing loss, but confirmatory evidence is not available as yet. Analysis of more cases is necessary to determine the utility of BAEP monitoring to predict delayed hearing loss after MVD and to identify its exact cause.

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Min Ho Lee, Seunghoon Lee, Jeong-A Lee & Kwan Park

  2. Department of Neurology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea

    Sang-Ku Park

Authors
  1. Min Ho Lee
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  2. Seunghoon Lee
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  3. Sang-Ku Park
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  4. Jeong-A Lee
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  5. Kwan Park
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Corresponding author

Correspondence to Kwan Park.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institutional Review Board of Samsung Medical Center/SMC 2014-04-028-001) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The requirement for informed consent was waived, as the study used existing clinical data.

Additional information

This article is part of the Topical Collection on Functional Neurosurgery - Other

Electronic supplementary material

Supplementary Fig. 1

Case illustration (case no. 1). A 43-year-old woman underwent MVD for HFS. (a) During the operation, initially, BAEP showed no unusual findings. (b) Intra-operatively, sudden prolongation of waves I–III inter-peak latency was observed. There was a prolongation of 0.63ms, from 1.80ms to 2.43ms. (c) BAEP findings improved to some extent before finishing the surgery. (d) Preoperatively, PTA/SDS were within normal limits. (e) On postoperative day 3, the patient had normal hearing test results and she was discharged from hospital. (f) On postoperative day 37, the patient complained of hearing difficulty and tests confirmed high-frequency SNHL. Steroid treatment was prescribed. (g) Three months after the operation, hearing had improved to preoperative level. (JPG 16544 kb)

Supplementary Fig. 2

Case illustration (case no. 2) A 57-year-old woman underwent MVD for HFS. (a)During the operation, initially, BAEP showed no unusual findings. (b) Intra-operatively, mild prolongation of waves I–III inter-peak latency was observed. There was a prolongation of 0.60ms, from 2.37ms to 2.97ms. (c) BAEP findings improved before finishing the surgery. (d) Preoperatively, PTA/SDS were within normal limits. (e) On postoperative day 3, the patient had normal hearing test results and she was discharged from hospital. (f) On postoperative day 45, the patient complained of dizziness and hearing difficulty and tests confirmed ipsilateral SNHL. Steroid treatment was prescribed. (g) Two months after the operation, hearing had improved to preoperative level. (JPG 15222 kb)

Supplementary Fig. 3

Case illustration (case no. 3). A 56-year-old woman underwent MVD for HFS. (a) During the operation, initially, BAEP showed no unusual findings. (b) Intra-operatively, mild prolongation of waves I–III inter-peak latency was observed. There was a prolongation of 0.56ms, from 2.27ms to 2.83ms. (c) BAEP findings improved to some extent before finishing the surgery. (d) Preoperatively, the patient had mild hearing loss on the PTA / SDS test. (e) Hearing test results at 3 days after surgery showed no significant difference from preoperative. (f) On postoperative day 18, the patient complained of sudden hearing difficulty and tests confirmed significant hearing loss. Steroid treatment was prescribed. (g) one month after the operation, hearing test showed mild improvement. (JPG 15493 kb)

Supplementary Fig. 4

Case illustration (case no. 4). A 50-year-old man underwent MVD for HFS. (a) During the operation, initially, BAEP showed no unusual findings. (b) Intra-operatively, sudden prolongation of waves I–III inter-peak latency was observed. There was a prolongation of 0.40ms, from 2.30ms to 2.70ms. (c) BAEP findings improved to some extent before finishing the surgery. (d) Preoperatively, PTA/SDS were within normal limits. (e) On postoperative day 3, the patient had normal hearing test results with mild middle ear effusion. (f) On postoperative day 10, the patient complained of sudden hearing difficulty and visited local hospital nearby, and tests confirmed high-frequency SNHL. Steroid treatment was prescribed. (g) One month after the operation, hearing had improved to preoperative level. (JPG 15290 kb)

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Lee, M.H., Lee, S., Park, SK. et al. Delayed hearing loss after microvascular decompression for hemifacial spasm. Acta Neurochir 161, 503–508 (2019). https://doi.org/10.1007/s00701-018-3774-7

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  • DOI: https://doi.org/10.1007/s00701-018-3774-7

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