Naira Mkrtchyan1, Lauranne Alciato1,2, Michel Kalamarides3, Daniele Bernardeschi1, Olivier Sterkers1,2, Isabelle Bernat4, Mustapha Smail1, Nadya Pyatigorskaya5, Ghizlene Lahlou6,7. 1. Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département d'Oto-Rhino-Laryngologie, APHP Sorbonne Université, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. 2. Institut de l'Audition/Institut Pasteur, Équipe TGTD «Technologies and Gene Therapy for Deafness», Paris, France. 3. Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département de Neurochirurgie, APHP Sorbonne Université, Paris, France. 4. Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département de Neurologie, APHP Sorbonne Université, Paris, France. 5. Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département de Neuroradiologie, APHP Sorbonne Université, Paris, France. 6. Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Département d'Oto-Rhino-Laryngologie, APHP Sorbonne Université, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. ghizlene.lahlou@aphp.fr. 7. Institut de l'Audition/Institut Pasteur, Équipe TGTD «Technologies and Gene Therapy for Deafness», Paris, France. ghizlene.lahlou@aphp.fr.
Abstract
PURPOSE: Post-operative outcomes for hearing after resection surgery to remove cerebellopontine angle (CPA) tumors other than vestibular schwannomas (VS) are not well understood. This study presents a series of patients with significant post-operative hearing recovery, trying to define the incidence among all patients operated on for removal of non-VS CPA tumors. METHODS: This is a retrospective observational case series of 8 patients among 69 operated on for removal of non-VS CPA tumors between 2012 and 2020. All patients had pre- and post-operative hearing measurement with pure-tone average (PTA) and speech discrimination score (SDS), according to the American Academy of Otolaryngology-Head and Neck Surgery recommendations, auditory brainstem response (ABR) measurements and imaging. RESULTS: Six meningiomas and two lower cranial nerve schwannomas operated on with a retrosigmoid approach were included for analysis. The mean pre-operative PTA and SDS were 58 ± 20.7 dB and 13 ± 17.5%, respectively. All patients had pre-operative class D hearing and asynchronous ABRs. They all showed significant hearing recovery, with an improvement of 36 ± 22.2 dB (p = 0.0025) and 85 ± 16.9% (p = 0.0001) in PTA and SDS, respectively, with mean follow-up of 21 ± 23.5 months. Seven patients recovered to a class A hearing level and one patient to class B. The ABRs became synchronous for three patients. The incidence of auditory recovery was 13% for patients operated on with a conservative approach (n = 60). CONCLUSION: A significant post-operative improvement in hearing could be a reasonable expectation in non-VS tumors extending into the CPA and a retrosigmoid approach should always be considered regardless of pre-operative hearing status.
PURPOSE: Post-operative outcomes for hearing after resection surgery to remove cerebellopontine angle (CPA) tumors other than vestibular schwannomas (VS) are not well understood. This study presents a series of patients with significant post-operative hearing recovery, trying to define the incidence among all patients operated on for removal of non-VS CPA tumors. METHODS: This is a retrospective observational case series of 8 patients among 69 operated on for removal of non-VS CPA tumors between 2012 and 2020. All patients had pre- and post-operative hearing measurement with pure-tone average (PTA) and speech discrimination score (SDS), according to the American Academy of Otolaryngology-Head and Neck Surgery recommendations, auditory brainstem response (ABR) measurements and imaging. RESULTS: Six meningiomas and two lower cranial nerve schwannomas operated on with a retrosigmoid approach were included for analysis. The mean pre-operative PTA and SDS were 58 ± 20.7 dB and 13 ± 17.5%, respectively. All patients had pre-operative class D hearing and asynchronous ABRs. They all showed significant hearing recovery, with an improvement of 36 ± 22.2 dB (p = 0.0025) and 85 ± 16.9% (p = 0.0001) in PTA and SDS, respectively, with mean follow-up of 21 ± 23.5 months. Seven patients recovered to a class A hearing level and one patient to class B. The ABRs became synchronous for three patients. The incidence of auditory recovery was 13% for patients operated on with a conservative approach (n = 60). CONCLUSION: A significant post-operative improvement in hearing could be a reasonable expectation in non-VS tumors extending into the CPA and a retrosigmoid approach should always be considered regardless of pre-operative hearing status.
Authors: Nida Fatima; Anne K Maxwell; Anna La Dine; Zachary R Barnard; Gautam U Mehta; Eric P Wilkinson; Derald E Brackmann; William H Slattery; Gregory P Lekovic Journal: J Neurooncol Date: 2022-02-03 Impact factor: 4.130