Inner ear extension of vestibular schwannomas.
OBJECTIVE
Inner ear extension of vestibular schwannomas (VSs) is a rare finding but has important clinical implications. This report reviews the treatment options and presents the experience of the Gruppo Otologico, Piacenza, Italy, in this field.


METHODS
Case report and literature review.


METHODS
Five cases of VSs with inner ear extension were surgically removed. In all of them, the cochlea was partially or completely invaded by the lesion.


RESULTS
In 4 cases, the inner ear extension was preoperatively identified on magnetic resonance imaging, and the surgical removal was planned through a transotic approach. In the last case, the cochlear invasion was not detected preoperatively, and the lesion was removed during a second surgery performed to seal a cerebrospinal fluid fistula.


CONCLUSIONS
VSs with inner ear extension should be distinguished from pure intralabyrinthine schwannomas because of differences in clinical significance. Cochlear involvement is more frequent than vestibular involvement and is often accompanied by a dead ear. Dead ear caused by small VSs should alert the surgeon to the possibility of a cochlear extension. The presence of an intracochlear involvement requires the adoption of an approach that allows control of the cochlear turns, and we found the transotic approach to be the most suitable. Undetected cochlear extensions that are left in place may grow with time.
Falcioni
Maurizio
M
Gruppo Otologico, Piacenza, Italy. maurizio.falcioni@gruppootologico.it
Taibah
Abdelkader
A
Di Trapani
Giuseppe
G
Khrais
Tarek
T
Sanna
Mario
M
D000328:Adult; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D004428:Ear Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D007758:Ear, Inner / Q000473:pathology / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007759:Labyrinth Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000209:etiology / Q000601:surgery; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation