Hearing preservation and intraoperative auditory brainstem response and cochlear nerve compound action potential monitoring in the removal of small acoustic neurinoma via the retrosigmoid approach

I Yamakami
February 2009
Journal of Neurology, Neurosurgery & Psychiatry;Feb2009, Vol. 80 Issue 2, p218
Academic Journal
OBJECTIVE: Hearing preservation is the main focus of small acoustic neurinoma (AN) removal. Refinement of intraoperative auditory monitoring may improve postoperative hearing. We have introduced a newly designed intracranial electrode enabling continuous monitoring of the cochlear nerve compound action potential (CNAP). We performed simultaneous monitoring of the auditory brainstem response (ABR) and CNAP during retrosigmoid small AN removal, and clarified the surgical outcome and the usefulness of CNAP monitoring. METHODS: Twenty-two consecutive patients with a small AN underwent retrosigmoid tumour removal with attempting hearing preservation. ABR and CNAP were simultaneously monitored during tumour removal. RESULTS: AN was totally removed in all patients without facial palsy. Preservation rate of useful and serviceable hearing was 82% and 91%, respectively. During microsurgical tumour removal, various surgical equipments and procedures intensified artefacts of ABR, and reliable ABR monitoring with distinct wave V was obtained in 9/22 patients. Unaffected by artefacts, reliable CNAP monitoring was obtained more frequently (in 20/22 patients) than ABR (p = 0.0005). CNAP on completion of tumour removal predicted hearing preservation with no false positive or negative (100% sensitivity and 100% specificity). CNAP changed dynamically and stepwise with surgical manipulations. CONCLUSION: The retrosigmoid approach using auditory monitoring for a small AN can accomplish total tumour removal with an excellent hearing preservation rate. CNAP provides reliable auditory monitoring more frequently than ABR, reflects the intraoperative auditory function almost in real-time, predicts postoperative hearing with excellent sensitivity and specificity, and is more useful for monitoring in the removal of small AN with hearing preservation.


Related Articles

  • Combined Intra-Operative Monitoring of Hearing by Means of Auditory Brainstem Responses (ABR) and Transtympanic Electrocochleography (ECochG) During Surgery of Intra- and Extrameatal Acoustic Neurinomas. Schlake, H.-P.; Milewski, C.; Goldbrunner, R. H.; Kindgen, A.; Riemann, R.; Helms, J.; Roosen, K. // Acta Neurochirurgica;Oct2001, Vol. 143 Issue 10, p985 

    Summary. Background: Although being established as a standard procedure in intra-operative monitoring in acoustic neurinoma surgery, auditory brainstem responses (ABR) represent a far-field technique bearing some technical limitations. This prospective study was designed to evaluate...

  • A new method for analyzing auditory brain-stem response waveforms using a moving-minimum subtraction procedure of digitized analog recordings. Källstrand, Johan; Lewander, Tommy; Baghdassarian, Eva; Nielzén, Sören // Neuropsychiatric Disease & Treatment;2014, Vol. 10, p1011 

    The auditory brain-stem response (ABR) waveform comprises a set of waves (labeled I-VII) recorded with scalp electrodes over 10 ms after an auditory stimulation with a brief click sound. Quite often, the waves are fused (confluent) and baseline-irregular and sloped, making wave latencies and...

  • REHABILITATIVE OUTCOMES IN DEAF CHILDREN WITH BRAINSTEM HYPOPLASIA-TWO CASES. Özkan, Hilal Burcu; Aslan, Filiz; Yaralı, Mehmet; Çınar, Betül Çiçek; Yücel, Esra; Sennaroğlu, Gonca; Sennaroğlu, Levent // Journal of International Advanced Otology;May2015 Supplement, Vol. 11, p82 

    AIM: The purpose of the study is to share our experiences with complex cases with bilateral profound hearing loss. The impact of these early life periods (cognitive, language etc.) on child development is essential to predict the improvements of communication skills. MATERIALS and METHODS: One...

  • Conscience in health care and the definitions of death. Kato, Yutaka // Croatian Medical Journal;Feb2013, Vol. 54 Issue 1, p75 

    Brain death or neurologic death has gradually become recognized as human death over the past decades worldwide. Nevertheless, in Japan, the New York State, and the State of New Jersey, one can be exempt from death determination based on neurologic criteria even in the state of brain death. In...

  • Anaplastic Ganglioglioma of the Brainstem in an Adult. González Toledo, E.; Nader, M.; Thomas-Ogunniyi, J.; Wilson, J. // Neuroradiology Journal;Jun2012, Vol. 25 Issue 3, p325 

    Gangliogliomas are neoplasms with neuronal and glial components. The most com­mon location is the temporal lobe and for that reason those patients have seizures as the major complaint. Gangliogliomas with anaplastic features are uncommon. A 33-year-old man presented with a two-year history of...

  • Ipsilateral and contralateral vestibular schwannomas in unilateral long-term deaf ears. Shih-Ming Chu; Yi-Ho Young // European Archives of Oto-Rhino-Laryngology;Jun2007, Vol. 264 Issue 6, p693 

    In the past decade, we have encountered two patients with unilateral long-term deaf ear having vestibular schwannoma. One was on the deaf ear in a 53 years’ woman and the other was on the contralateral hearing ear in a 62 years’ woman. These two patients had total deafness on the...

  • A Rare Case of Hearing Impairment due to Cerebello-Pontine Angle Lesion: Trigeminal Schwannoma. Ganesan, Purushothaman; Sankaran, Priya; Kothandaraman, Purushothaman Pavanjur // Journal of International Advanced Otology;Aug2015, Vol. 11 Issue 2, p170 

    Schwannoma of the trigeminal nerve is a rare condition. Even rarer is hearing loss occurring as a result of this lesion. The aim of this study is to highlight this rare cause of hearing impairment. Here we report the clinical features and findings of the imaging and audiological investigations...

  • ABR Tools for Retrocochlear and Cochlear Assessment. Don, Manuel // ASHA Leader;12/26/2007, Vol. 12 Issue 17, p8 

    The article reports on assessment tools for retrocochlear and cochlear assessment. Assessment was done with noninvasive auditory brainstem responses but they have been lacking in the detection of tumors and the diagnosis of Meniere's disease. Meniere's disease effects the inner ear. Magnetic...

  • Treatment of recurrent diffuse intrinsic pontine glioma: the MD Anderson Cancer Center experience. Wolff, Johannes; Rytting, Michael; Vats, Tribhawan; Zage, Peter; Ater, Joann; Woo, Shiao; Kuttesch, John; Ketonen, Leena; Mahajan, Anita // Journal of Neuro-Oncology;Jan2012, Vol. 106 Issue 2, p391 

    Recurrent diffuse intrinsic pontine gliomas (DIPG) are traditionally treated with palliative care since no effective treatments have been described for these tumors. Recently, clinical studies have been emerging, and individualized treatment is attempted more frequently. However, an informative...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics