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Published on: May 26, 2023
Outcome after microsurgery for meningiomas involving the internal auditory canal
Kajetan L von Eckardstein1, Colin L W Driscoll, Michael J Link
1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background:
The subset of patients suffering from meningiomas truly originating in or extending into the internal auditory canal is not well described in the literature.
Objective:
To evaluate postoperative facial motor and hearing outcomes in patients undergoing resection of meningiomas originating in or extending into the internal auditory canal.
Methods:
Chart reviews were done of 19 consecutive patients undergoing surgery for meningiomas originating in or extending into the internal auditory canal at the Mayo Clinic, Rochester, with emphasis on clinical exam and audiometry.
Results:
Median follow-up for the entire group was 29 months. Seventy-four percent of patients had stable facial nerve function. One patient experienced improvement. Postoperative cochlear nerve function was unchanged in 74% of patients and worsened in 21% of patients. One patient with a sudden preoperative hearing loss improved to full hearing at 3 months.
Conclusion:
Every attempt should be made to preserve hearing and facial motor function in surgical removal of posterior fossa meningiomas that originate in or extend into the internal auditory canal. Normal or nearly normal facial nerve function can be preserved in 88% of patients presenting with normal facial nerve function; serviceable hearing can be preserved in 92% of patients who present with normal hearing. A standard retrosigmoid craniotomy with drilling of the posterior canal wall of the internal auditory canal worked well in the majority of cases.
Insights
Surgical removal of meningiomas in the internal auditory canal can preserve facial nerve function in most patients. Hearing preservation is also achievable, with a standard retrosigmoid craniotomy being an effective surgical approach.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Meningiomas involving the internal auditory canal (IAC) are rare and poorly documented.
- Understanding outcomes for these specific tumors is crucial for surgical planning.
Purpose of the Study:
- To assess postoperative facial nerve and hearing outcomes after IAC meningioma resection.
- To identify factors influencing functional preservation in these challenging cases.
Main Methods:
- Retrospective chart review of 19 patients with IAC meningiomas at Mayo Clinic.
- Analysis of clinical examinations and audiometric data pre- and post-surgery.
Main Results:
- Facial nerve function remained stable in 74% of patients; 88% with normal preoperative function maintained it.
- Cochlear nerve function was unchanged in 74% of patients; 21% experienced worsening.
- Serviceable hearing was preserved in 92% of patients with normal preoperative hearing.
Conclusions:
- Prioritizing hearing and facial nerve preservation is essential during IAC meningioma surgery.
- Retrosigmoid craniotomy with posterior canal wall drilling is a successful technique.
- High rates of functional preservation are achievable with careful surgical management.
