Summary
900 acoustic neurinomas were removed by the suboccipital approach at Nordstadt Neurosurgical Department from 1978 to 1992 by the same surgeon (M. S.). While 247 patients were deaf on the involved side before surgery, there were 653 patients ears with some preoperative hearing. Preservation of the cochlear nerve was always attempted, and the overall-rate of hearing preservation was 38% (249 of 653), regardless of pre- and postoperative quality of hearing or of tumour sizes. In small tumour sizes below 3 cm of diameter preservation rate was 51%, in large tumours above 3 cm of diameter it was 22%. A classification system of hearing quality was made up considering pure tone audiometric hearing losses (PTA HL) at 1 to 3 kHz, and individual maximum speech discrimination scores. The usefulness of the preserved hearing is further evaluated considering the quality of hearing in the contralateral ear, and by application of other classification schemes. Presentation of the surgical strategies and their refinements by personal experience provide the base for discussion questioning whether and how further progress may still be anticipated.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Baldwin DL, King TT, Morrison AW (1990) Hearing conservation in acoustic neuroma surgery via the posterior fossa. J Laryngol Otol 104 (6): 463–467
Belal A Jr, Linthicum FH, House WP (1982) Acoustic tumour surgery with preservation of hearing. A histopathological report. Am J Otol 4: 9–16
Bentivoglio P, Cheesman AD, Symon L (1988) Surgical management of acoustic neuromas during the last five years. Part II: Results for facial and cochlear nerve function. Surg Neurol 29: 205–209
Brackmann DE, Green JD (1992) Translabyrinthine approach for acoustic tumor removal. Otolaryngol Clin North Am 25 (2): 311–329
Cohen NL (1979) Acoustic neuroma surgery with emphasis on preservation of hearing. Laryngoscope 89: 886–896
Cohen NL, Ransohoff J (1984) Hearing preservation - posterior fossa approach. Otolaryngol Head Neck Surg 92 (2): 176–183
Cohen NL, Hammerschlag P, Berg H, Ransohoff J (1986) Acoustic neuroma surgery: an eclectic approach with emphasis on preservation of hearing. Ann Otol Rhinol Laryngol 95: 21–27
Cohen NL (1992) Retrosigmoid approach for acoustic tumor removal. Otolaryngol Clin North Am 25 (2): 295–310
Darrouzet V, Maire JP, Flocquet A, Guerin J, Bebear JP (1990) Irradiation of neurinoma. Why? How? First results. (L’irradiation des neurinomes. Pourquoi? Comment? Premiers resultats.) Rev Laryngol Otol Rhinol Bord 111 (3): 211–215
Eckermeier L, Pirsig W, Mueller D (1979) Histopathology of 30 non-operated acoustic schwannomas. Arch Otorhinolaryngol 222: 1–9
Fischer G, Morgon A, Fischer C, Bret Ph, Massini B, Kzaiz M, Chariot M (1987) Total removal of acoustic neuromas. Facial nerve and hearing preservation. Exérèse complete des neurinomes de l’acoustique. Preservation du nerf facial et de l’audition. Neurochirurgie 33: 169–183
Fischer G, Fischer C, Remond J (1992) Hearing preservation in acoustic neurinoma surgery. Comment. J Neurosurg 76 (6): 897–900; J Neurosurg 76 (6): 910–917
Forton G, Moeneclaey L, Declau F, Marquet J (1989) The involvement of the cochlear nerve in neurinomas of the eighth cranial nerve. Arch Otorhinolaryngol 246: 156–160
Frerebeau P, Benezech J, Uziel A, Coubes P, Segnarbieux F, Malonga M (1987) Hearing preservation after acoustic neurinoma operation. Neurosurgery 21 (2): 197–200
Gadre AK, Kwartler JA, Brackmann DE, House WF, Hitselberger WE (1990) Middle fossa decompression of the internal auditory canal in acoustic neuroma surgery: a therapeutic alternative. Laryngoscope 100: 948–952
Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97 (1): 55–66
Giannotta SL (1992) Translabyrinthine approach for removal of medium and large tumors of the cerebellopontine angle. Clin Neurosurg 38: 589–602
Glasscock ME III, Kveton JF, Jackson CG, Levine SC, McKennan KX (1986) A systematic approach to the surgical management of acoustic neuromas. Laryngoscope 96: 1088–1094
Glasscock ME III, Hays JW, Minor LB, Haynes DS, Carrasco VN (1993) Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 78: 864–870
Haines SJ, Levine SC (1993) Intracanalicular acoustic neuroma: early surgery for preservation of hearing. J Neurosurg 79: 515–520
Harner SG, Laws ER Jr, Onofrio BM (1984) Hearing preservation after removal of acoustic neurinoma. Laryngoscope 94 (11): 1431–1434
Harner SG, Beatty CW, Ebersold MJ (1990) Rterosigmoid removal of acoustic neuroma: experience 1978–1988. Otolaryngol Head Neck Surg 103: 40–45
Helms J (1992) Hearing preservation in acoustic neurinoma surgery. Otolaryngol Pol 46 (6): 533–537
Hinton AE, Ramsden RT, Lye RH, Dutton JE (1992) Criteria for hearing preservation in acoustic schwannoma surgery: the concept of useful hearing. J Laryngol Otol 106: 500–503
House WF (1964) Transtemporal bone microsurgical removal of acoustic neuromas. Report of cases. Arch Otolaryngol 80: 667
House WF, Hitselberger WE (1985) The neurootologist’s view of the surgical management of acoustic neuromas. Clin Neurosurg 32: 214–222
House WF, Shelton C (1992) Middle fossa approach for acoustic tumor removal. Otolaryngol Clin North Am 25 (2): 347–359
Hughes GB, Sismanis A, Glasscock ME III, Hays JW, Jackson CG (1982) Management of bilateral acoustic tumors. Laryngoscope 92 (12): 1351–1359
Jacob U, Gerhardt HJ, Staudt J, Dilba V (1990) Chirurgische Anatomie der Pars petrosa und der Fossa cranii posterior unter dem Aspekt der Hörerhaltung bei der Operation von Akustikusneurinomen. (Surgical anatomy of the petrous canal and posterior cranial fossa in relation to hearing preservation in surgery of acoustic neuroma). HNO 38 (3): 83–91
Jannetta PJ, Moller AR, Moller MB (1984) Technique of hearing preservation in small acoustic neuromas. Ann Surg 200: 513–522
Kanzaki J, Ogawa K, Shiobara R, Toya S (1989) Hearing preservation in acoustic neuroma surgery and postoperative audiological findings. Acta Otolaryngol Stockh 107 (5–6): 474–78
Kemink JL, La Rouere MJ, Kileny PR, Telian SA, Hoff JT (1990) Hearing preservation following suboccipital removal of acoustic neuromas. Layngo-scope 100: 597–602
Kveton JF (1990) Delayed spontaneous return of hearing after acoustic tumor surgery evidence for cochlear nerve conduction block. Laryngoscope 100: 473–476
Kveton JF (1990) The efficacy of brainstem auditory evoked potentials in acoustic tumor surgery. Laryngoscope 100 (11): 1171–1173
Levine RA, Bu-Saba N, Brown MC (1993) Laser-Doppler measurements and electrocochleography during ischemia of the guinea pig cochlea: implications for hearing preservation in acoustic neuroma surgery. Ann Otol Rhinol Laryngol 102 (2): 127–136
Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D (1992) Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin North Am 3 (1): 191–205
Lunsford LD, Linskey ME (1992) Stereotactic radiosurgery in the treatment of patients with acoustic tumors. Otolaryngol Clin North Am 25 (2): 471–491
Maddox HE (1977) The lateral approach to acoustic tumors. Laryngoscope 87 (9): 1572–1578
Maniglia AJ, Fenstermaker RA, Ratcheson RA (1989) Preservation of hearing in the surgical removal of cerebellopontine angle tumors. Otolaryngol Clin North Am 22(1): 211–232
Marquet JF, Forton GE, Offeciers FE, Moeneclaey LL (1990) The solitary schwannoma of the eighth cranial nerve. An immunohistochemical study of the cochlear nerve-tumor interface. Arch Otolaryngol Head Neck Surg 116 (9): 1023–1025
McElveen JT Jr, Wilkins RH, Erwin AC, Wolford RD (1991) Modifying the translabyrinthine approach to preserve hearing during acoustic tumour surgery. J Laryngol Otol 105 (1): 34–37
McKenna MJ, Halpin C, Ojemann RG, Nadol JB Jr, Montgomery WW, Levine RA, Carlisle E, Martuza R (1992) Long-term hearing results in patients after surgical removal of acoustic tumors with hearing preservation. Am J Otol 13 (2): 134–136
Miyamoto RT, Roos KL, Campbell RL Worth RM (1991) Contemporary management of neurofibromatosis. Ann Otol Rhinol Laryngol 100(1): 38–43
Montgomery WW (1978) Bilateral acoustic neurinomas. A case report. Ann Otol Rhinol Laryngol 87 (1): 135–137
Nadol JB Jr, Chiong CM, Ojemann RG, McKenna MJ, Martuza RL, Montgomery WW, Levine RA, Ronner SF, Glynn RJ (1992) Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope 102 (10): 1153–1158
Nadol JB (1993) Review article. Medical progress: hearing loss. N Engl J Med 329(15): 1092–1102
Nedzelski JM, Tator CH (1984) Hearing preservation: a realistic goal in surgical removal of cerebellopontine angle tumors. J Otolaryngol 13 (6): 355–360
Neely JG (1984) Is it possible to totally resect an acoustic tumor and conserve hearing. Otolaryngol Head Neck Surg 92: 162–167
Neely JG (1985) Hearing conservation surgery for acoustic tumors — a clinical- pathologic correlative study. Am J Otol [Suppl]: 143–146
Nehls DG, Spetzler RF, Shetter AG, Sonntag VKH (1985) Application of new technology in the treatment of cerebellopontine angle tumors. Clin Neurosurg 32: 223–241
Ogawa K, Kanzaki J, Ogawa S, Tsuchihashi N, Ikeda S (1991) Progression of hearing loss in acoustic neuromas. Acta Otolaryngol [Suppl] (Stockh) 487: 133–137
Ojemann RG, Levine RA, Montgomery WM, McGaffigan P (1984) Use of intraoperative auditory evoked potentials to preserve hearing in unilateral acoustic neuroma removal. J Neurosurg 61: 938–948
Palva T, Troupp H, Jauhiainen T (1985) Hearing preservation in acoustic neurinoma surgery. Acta Otolaryngol Stockh 99 (1–2): 1–7
Rand R, Kurze T (1968) Case reports and technical notes: preservation of vestibular, cochlear and facial nerves during microsurgical removal of acoustic tumours. J Neurosurg 28: 158
Rhoton AL Jr (1974) Microsurgery of the internal acoustic meatus. Surg Neurol 2: 311–318
Rhoton A (1976) Microsurgical removal of acoustic neuromas. Surg Neurol 6:211
Rosenberg RA, Cohen NL, Ransohoff J (1987) Long-term hearing preservation after acoustic neuroma surgery. Otolaryngol Head Neck Surg 97: 270–274
Rowed DW, Nedzelski JM, Cashman MZ, Stanton S, Harrison RV (1988) Cochlear nerve monitoring during cerebellopontine angle operations. Can J Neurol Sci 15 (1): 68–72
Samii M, Turel KE, Penkert G (1985) Management of seventh and eighth nerve involvement by cerebelloponline angle tumors. Clin Neurosurg 32: 242–272
Samii M (1989) Tumors of the internal auditory canal and cerebellopontine angle. I. Acoustic neuroma. In: Samii M, Draf W (eds) Surgery of the skull base. An interdisciplinary approach. Springer, Berlin Heidelberg New York Tokyo, pp 377–395
Sanna M, Zini C, Mazzoni A, Gandolfi A, Pareschi R, Pasanisi E, Gamoletti R (1987) Hearing preservation in acoustic neuroma surgery. Middle fossa versus suboccipital approach. Am J Otol 8 (6): 500–506
Schessel DA. Nedzelski JM, Kassel EE, Rowed DW (1992) Recurrence rates of acoustic neuroma in hearing preservation surgery. Am J Otol 13 (3): 233–235
Shelton C, Brackmann DE, House WF, Hitselberger (1989 a) Middle fossa acoustic tumor surgery: results in 106 cases. Laryngoscope 99: 405–408
Shelton C, Brackmann DE, House WF, Hitselberger WE (1989b) Acoustic tumor surgery. Prognostic factors in hearing conversation. Arch Otolaryngol Head Neck Surg 115 (10): 1213–1216
Shelton C, Hitselberger WE, House WF, Brackmann DE (1990) Hearing preservation after acoustic tumor removal: long-term results. Laryngoscope 100: 115–119
Shelton C, House WF (1990 c) Hearing improvement after acoustic tumor removal. Otolaryngol Head Neck Surg 103 (6): 963–965
Shelton C, Hitselberger WE (1991) The treatment of small acoustic tumors: now or later? Laryngoscope 101 (9): 925–928
Shelton C (1992) Hearing preservation in acoustic tumor surgery. Otolaryngol Clin North Am 25 (3): 609–621
Silverstein H, McDaniel AB, Norrell H (1985) Hearing preservation after acoustic neuroma surgery using intraoperative direct eighth cranial nerve monitoring. Am J Otol [Suppl]: 99–106
Silverstein H, McDaniel A, Norrell H, Haberkamp T (1986) Hearing preservation after acoustic neuroma surgery with intraooerative direct eighth cranial nerve monitoring: Part II. A classification of results. Otolaryngol Head Neck Surg 95 (3): 285–291
Silverstein H, Rosenberg SI, Flanzer JM, Wanamaker HH, Seidman MD (1993) An algorithm for the management of acoustic neuromas regarding age, hearin, tumor size, and symptoms. Otolaryngol Head Neck Surg 108 (1): 1–10
Slavit DH, Hamer SG, Harper CM Jr, Beatty CW (1991) Auditory monitoring during acoustic neuroma removal. Arch Otolaryngol Head Neck Surg 117(10): 1153–1157
Smith MF, Clancy TP, Lang JS (1977) Conservation of hearing in acoustic neurilemmoma excision. Trans Am Acad Ophthalmol Otolaryngol 84: 704–709
Smith MFW, Lagger RL (1984) Hearing conservation in acoustic neurilemmoma surgery via the retrosigmoid approach. Otolaryngol Head Neck Surg 92: 168–175
Sterkers JM, Hamann IKIE (1979) The retrosigmoid approach: a possibility to preserve hearing function in operations of acoustic neuroma. Arch Otolaryngol 223: 463
Sterkers JM (1982) Preservation de l’audition dans la chirurgie du neurinome de l’acoustique par la voie d’abord retrosigmoid (80 cas). Rev Laryngol 103: 21
Sterkers JM, Desgeorges M, Sterkers O, Corlieu P, Viala P (1986) Chirurgie du neurinome de l’acoustique et autres tumeurs du conduit auditif interne et de l’angle ponto-cerebelleux. A propos de 602 cas. (Surgery of acoustic neuroma and other tumors of the internal auditory canal and cerebellopontile angle. Apropos of 602 cases). Ann Otolaryngol Chir Cervicofac 103: 487–492
Strauss C, Fahlbusch R, Berg M, Haid T (1989) Funktionserhaitende Mikrochirurgie bei der suboccipitalen Entfernung großer Akustikusneurinome. (Function-saving microsurgery in suboccipital removal of large acoustic neuromas). HNO 37 (7): 281–286
Sugita K, Kobayashi S, Mutsuga N, Suzuki Y, Mizutani T, Shibuya M, Kageyama N, Tanahashi T (1979) Microsurgery for acoustic neurinoma — lateral position and preservation of facial and cochlear nerves. Neurol Med Cir 19: 637–641
Sugita K, Kobayashi S (1982) Technical instrumental improvements in the surgical treatment of acoustic neurinomas. J Neurosurg 57: 747–752
Symon L, Sabin HI, Bentivoglio P, Cheesman AD, Prasher D, Barratt H (1988) Intraoperative monitoring of the electrocochleogram and the preservation of hearing during acoustic neuroma excision. Acta Neurochir Wien [Suppl] 42: 27–30
Symon L, Bordi L, Compton JS, Sabin IH, Sayin E (1989) Acoustic neuroma: a review of 392 cases. Br J Neurosurg 3: 343–348
Tator CH, Nedzelski JM (1985) Preservation of hearing inpatients undergoing excision of acoustic neuromas and other cerebellopontine angle tumors. J Neurosurg 63: 168–174
Telian SA, Kemink JL, Kileny P (1988) Hearing recovery following suboccipital excision of acoustic neuroma. Arch Otolaryngol Head Neck Surg 114(1): 85–87
Thomsen J, Tos M, Harmsen A (1989/90) Acoustic neuroma surgery: results of translabyrinthine tumour removal in 300 patients. Discussion of choice of approach in relation to overall results and possibility of hearing preservation (see comments) CM: Comment in: Br J Neurosurg 3 (6): 741–743. Comment in: Br J Neurosurg 4 (4): 356. Br J Neurosurg 3 (3): 349–360
Valvassori GE, Guzman M (1989) Growth rate of acoustic neuromas. Am J Otol 10: 174–176
Von Gösseln HH, Samii M, Bini W (1991) The lounging position for posterior fossa surgery: anesthesiological considerations regarding air embolism. Childs Nerv Syst 7: 368–374
Wade PJ, House W (1984) Hearing preservation in patients with acoustic neuromas via the middle fossa approach. Otolaryngol Head Neck Surg 92 (2): 184–193
Wigand ME, Haid T, Berg M (1989) The enlarged middle cranial fossa approach for surgery of the temporal bone and of the cerebellopontine angle. Arch Otorhinolaryngol 246 (5): 299–302
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1995 Springer-Verlag/Wien
About this chapter
Cite this chapter
Samii, M., Matthies, C. (1995). Hearing Preservation in Acoustic Tumour Surgery. In: Symon, L., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 22. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6898-1_6
Download citation
DOI: https://doi.org/10.1007/978-3-7091-6898-1_6
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7428-9
Online ISBN: 978-3-7091-6898-1
eBook Packages: Springer Book Archive