Giacomo Esposito1, Raffaella Messina2, Andrea Carai1, Giovanna Stefania Colafati3, Alessandra Savioli4, Franco Randi1, Alessandro De Benedictis1, Silvia Cossu1, Marco Maria Fontanella5, Carlo Efisio Marras1. 1. Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 2. Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: raffaella.messina@opbg.net. 3. Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 4. Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 5. Neurosurgery Unit, Department of Neuroscience, Spedali Civili Hospital, Brescia, Italy.
Abstract
INTRODUCTION: Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic to systematically present the best available evidence to guide clinical decisions. METHODS: We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA)-cochleovestibular nerve neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's College guidelines. DISCUSSION: We found 35 studies of neurovascular compression of the cochleovestibular nerve by AICA for 536 patients operated on to resolve their neurovascular conflict. Only 4 of these studies describe intrameatal AICA neurovascular conflicts, for 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted of microsurgical mobilization of the AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery. CONCLUSIONS: Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long-term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss. Copyright Â
INTRODUCTION: Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic to systematically present the best available evidence to guide clinical decisions. METHODS: We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA)-cochleovestibular nerve neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's College guidelines. DISCUSSION: We found 35 studies of neurovascular compression of the cochleovestibular nerve by AICA for 536 patients operated on to resolve their neurovascular conflict. Only 4 of these studies describe intrameatal AICA neurovascular conflicts, for 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted of microsurgical mobilization of the AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery. CONCLUSIONS: Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long-term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss. Copyright Â
Authors: Fernando Alonso; Mohammad W Kassem; Joe Iwanaga; Rod J Oskouian; Marios Loukas; Amin Demerdash; R Shane Tubbs Journal: Cureus Date: 2017-08-16