Diagnosis and management of intracochlear schwannomas.
OBJECTIVE
To describe and analyze a series of intracochlear schwannomas.


METHODS
From 1987 to 2005, 19 patients with schwannomas involving the cochlea were included in this series. Clinical, audiovestibular, and imaging data concerning initial and follow-up visits were collected.


RESULTS
The mean age was 54 years (range, 25-71 yr). The series comprised 10 women and 9 men, 18 solitary tumors and 1 neurofibromatosis Type 2 patient. The mean diagnosis delay was 11 years (range, 1-31 yr). At diagnosis, a total or profound hearing loss (Class D of American Academy of Otolaryngology-Head and Neck Surgery classification) was noted in 17 patients (89%), and a severe loss (Class C) was reported in 2 patients (11%). Facial paresis was reported in 2 patients (11%; Grades 2 and 4 of House and Brackmann classification). Magnetic resonance imaging showed an involvement of the posterior labyrinth in 8 patients (37%), an extension of the schwannoma to the internal auditory meatus in 8 patients (37%), and a cerebellopontine angle extension in 7 patients (32%). In 11 patients (58%), the schwannoma was removed through a transotic route. In the 8 remaining patients, a watch-and-rescan policy was decided. The postoperative course was uneventful. Postoperative follow-up period was 27 months (range, 6-88 mo). Postoperative facial function was assessed as Grade 1 in 7 patients, as Grade 2 in 4, and as Grade 4 in 1 patient.


CONCLUSIONS
The diagnosis of intracochlear schwannomas can be difficult on magnetic resonance imaging. The diagnosis should be considered in all unilateral hearing losses.
Grayeli
Alexis Bozorg
AB
Department of Otolaryngology-Head and Neck Surgery, AP-HP, Beaujon Hospital, Clichy, France. alexis.bozorg-grayeli@bjn.aphp.fr
Fond
Cyril
C
Kalamarides
Michel
M
Bouccara
Didier
D
Cazals-Hatem
Dominique
D
Cyna-Gorse
Françoise
F
Sterkers
Olivier
O
D000328:Adult; D000368:Aged; D001299:Audiometry; D003051:Cochlea; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005158:Facial Paralysis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D013506:Otologic Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014724:Vestibular Function Tests; D000160:Vestibulocochlear Nerve Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*