Letter to the Editor: "Cochlear Patency after Translabyrinthine and Retrosigmoid Vestibular Schwannoma Surgery".

Dear editor:

At our institution and others, otologists are exploring the role of cochlear implantation after vestibular schwannoma excision.[1,2] Cochlear patency is clearly an important factor in determining implant candidacy. Your recently published article “Cochlear Patency after Translabyrinthine and Retrosigmoid Vestibular Schwannoma Surgery” highlights this well and contributes to the growing body of knowledge.[3] We recently evaluated our postsurgical population of vestibular schwannoma patients and similarly found that loss of patency was more frequent in the translabyrinthine approach than in labyrinth-sparing approaches.[4]

In our case series, however, we found an additional feature on early postoperative gadolinium-enhanced MRIs that is worth bringing to the attention of your readers. Cochlear enhancement was frequently associated with, and possibly proceeded, the loss of patency. We felt that this cochlear enhancement was intense and often more obvious than subtle losses of T2 intensity.

We echo van Waegeningh and colleagues’ call for early postoperative MRI imaging to assess for cochlear implant candidacy and help identify patients at risk for the obliteration of their cochlea. We would encourage your audience to also evaluate their patients’ T1 images with contrast, as this may be a clearer leading indicator.