Factors Influencing Cochlear Patency after Translabyrinthine Surgery

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiology

Background:

• Vestibular schwannoma (VS) surgery, particularly translabyrinthine (TL) approaches, can impact cochlear patency.
• Cochlear patency is essential for successful cochlear implantation in cases of unilateral deafness post-surgery.
• Predictive factors for maintaining cochlear patency after TL surgery require further investigation.

Purpose of the Study:

• To identify predictive factors for cochlear obliteration following translabyrinthine surgery for vestibular schwannoma.
• To assess the relationship between preoperative tumor characteristics, hearing metrics, and postoperative cochlear patency.

Main Methods:

• A retrospective chart review of 103 patients who underwent TL surgery for VS between 2010 and 2015.
• Postoperative magnetic resonance imaging (MRI), including heavily T2-weighted and FLAIR sequences, was analyzed to evaluate cochlear patency.
• Comparison of tumor size, audiometric data, and preoperative MRI FLAIR intensity between patients with and without cochlear patency.

Main Results:

• Fifty-four percent of patients maintained cochlear patency after TL surgery.
• No statistically significant differences were found in tumor size, speech reception thresholds, pure-tone average, word recognition scores, or preoperative MRI FLAIR intensity between patent and non-patent groups.
• Preoperative factors did not reliably predict cochlear patency post-surgery.

Conclusions:

• Cochlear patency is preserved in over half of patients after TL surgery for VS.
• Preoperative tumor size, hearing function, and MRI FLAIR signal intensity are not predictive of cochlear patency.
• Strategies like simultaneous cochlear implantation or cochlear lumen keeper placement may be considered to preserve hearing opportunities.