Case report and discussion of hearing preservation after translabyrinthine excision of small acoustic tumors.
OBJECTIVE
Since 1991, three separate reports have shown how hearing may be salvaged after translabyrinthine excision of small acoustic tumors. The authors submit yet another report of a complete translabyrinthine excision of a 1.4-cm intracanalicular acoustic tumor with modest hearing preservation. An attempt is made to retrace the steps of the operation and recognize and discuss what particular events may have safeguarded the viability of the cochlea. With the availability of cochlear implantation, there should be added incentive to preserve the cochlear neurones if hair cells cannot be saved.


METHODS
The study design was a retrospective case review.


METHODS
The study was conducted at a primary care hospital.


METHODS
Therapeutic and rehabilitative measures were performed.


METHODS
Hearing preservation was measured.


METHODS
A 55-year-old woman presented with a left-sided hearing loss and a 1.4-cm left acoustic tumor completely filling the internal auditory canal (speech reception threshold [SRT] 30 dB, discrimination [Pb] 28%). A successful translabyrinthine excision of the tumor was performed in November 1995. A 1-year postoperative audiogram showed a mixed hearing loss in the left ear with SRT 85 dB and Pb 0%. Average pure-tone threshold for 500 Hz, 1 kHz, and 3 kHz was 50 dB and aided SRT 40 dB with Pb 64%. Postoperative magnetic resonance imaging confirmed complete excision of the tumor.


CONCLUSIONS
An exceptional case of hearing preservation after translabyrinthine excision of a small acoustic tumor illustrates how it may be possible to preserve cochlear hair cells and neurones simultaneously in certain selected cases. A review of the surgical events shows the value of sealing the cochlear duct with bone wax, selectively removing the vestibular nerves with the tumor by sharp dissection, and safeguarding the meatal segment of the anterior inferior cerebellar artery by a limited dural incision.
Rizvi
S S
SS
Bay Medical Center, Department of Otolaryngology, Bay City, Michigan, USA.
Goyal
R N
RN
D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D007758:Ear, Inner / Q000601:surgery*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D009442:Neurilemmoma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D011182:Postoperative Care; D012189:Retrospective Studies; D013069:Speech Reception Threshold Test