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Vestibular Schwannomas: Neurology, Neurophysiology and Anatomy

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Vestibular Schwannoma Surgery

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Abstract

Seventh and eighth nerves originate from the lateral aspect of the brainstem, traverse CPA cistern and IAC terminate in the inner ear, where they provide innervation of the vestibular end organs. The CPA cistern is an expansion of the subarachnoid space between the lateral lobe of the cerebellum, cerebellar peduncles, and lateral pons medially and the temporal bone laterally. In the far lateral IAC, CoN enters the modiolus of the cochlea at the cochlear aperture, FN enters the meatal foramen to become the labyrinthine segment of FN, and the SVN & IVN enter the labyrinth of the inner ear. Chorda tympani nerve enters the middle ear just medial to the tympanic membrane through an opening, the iter chordae posterior, runs across the middle ear space and then exits the middle ear into the infratemporal fossa through Huguier’s canal. A series of interconnected spaces within the otic capsule form the bony labyrinth consisting of the cochlea, vestibule, semicircular canals and vestibular aqueduct. AICA, and occasionally the basilar artery provide the blood supply to the cochlea and vestibular organs through labyrinthine artery. Objective tinnitus is the perception of sound from an internal sound source such as turbulent blood flow within a vascular structure or blood pressure pulsations transmitted from the dura to the inner ear. Vertigo related to peripheral vestibular dysfunction is typically perceived as rotational movement and lasts for several hours to several days but eventually subsides as the central nervous system compensates for the peripheral dysfunction. Acoustic reflex thresholds are determined by playing a stimulus while monitoring for a change in the compliance of the middle ear system. Electrophysiologic testing of the inner ear and auditory system, ABR/BAER or ECoG has no significant role in diagnosis of VS as these tests have been replaced by cross sectional imaging. Facial Nerve Monitoring is commonly utilized during the surgical treatment of vestibular schwannoma and is particularly useful in medium and large sized tumors. However, FNM does not replace the detailed anatomic knowledge and technical skill required to operate near the facial nerve. Cochlear nerve physiology can be monitored intraoperatively when hearing preservation is a goal of surgery and provides the microsurgeon with a valuable tool for assessing the impact of surgical manipulations on the integrity and function of the auditory system.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sima Sayyahmelli & Burak Ozaydin

  2. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Lucas Leonhard

  3. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Otology/Neurotology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Joseph P. Roche

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  1. Sima Sayyahmelli
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Correspondence to Joseph P. Roche .

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Sayyahmelli, S., Leonhard, L., Ozaydin, B., Roche, J.P. (2019). Vestibular Schwannomas: Neurology, Neurophysiology and Anatomy. In: Vestibular Schwannoma Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-99298-3_2

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