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Published on: February 29, 2020
Impact of MRI Cochlear FLAIR Signal on Hearing Preservation after Middle Fossa Vestibular Schwannoma Resection
Nicole Ewer1, Samira Takkoush1, Jason L Steele2
1University of Utah School of Medicine, Salt Lake City, Utah.
Objective:
Literature is limited regarding the relationship between cochlear magnetic resonance imaging fluid-attenuated inversion recovery (FLAIR) signal and hearing preservation after resection of vestibular schwannoma (VS). We hypothesize that increased preoperative FLAIR signal is associated with decreased odds of hearing preservation.
Study Design:
Retrospective cohort study.
Setting:
Single academic tertiary/quaternary care center.
Patients:
Subjects with histologically confirmed intracanalicular VS (without extension into the cerebellopontine angle).
Intervention:
Microsurgical resection via middle fossa approach.
Main Outcome Measures:
A review of demographic, clinical, radiographic, and audiometric outcomes were performed. Hearing preservation was defined as American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B hearing. Binary logistic regression analysis was performed with SPSS version 29.
Results:
Twenty-seven subjects met inclusion criteria with median age at time of surgery of 47 (interquartile range [IQR]: 38-54) years; 92.60% were White; 66.67% had AAO-HNS class A, and 33.33% had class B hearing. Postoperatively, at median (IQR) of 11.50 (2.10-38.50) months, 44.40% had class A or B hearing. On logistic regression analysis, a ratio of cochlea-to-brainstem FLAIR signal greater than 0.6 was associated with decreased odds of hearing preservation at 11.50 months-odds ratio, 0.13; 95% confidence interval, 0.02-0.84. Age, sex, surgery duration, tumor volume and linear dimension, fundal cap of cerebrospinal fluid, and extent of resection were not associated with hearing preservation.
Conclusion:
Increased cochlear FLAIR signal on preoperative imaging is associated with decreased likelihood of hearing preservation after resection of intracanalicular, sporadic VS via middle fossa approach.
Insights
Preoperative cochlear fluid-attenuated inversion recovery (FLAIR) signal on MRI can predict hearing preservation after vestibular schwannoma (VS) surgery. Higher FLAIR signal indicates a lower chance of retaining hearing post-operation.
Area of Science:
- Neurosurgery
- Otolaryngology
- Radiology
- Oncology
Background:
- Vestibular schwannoma (VS) resection outcomes are crucial for patient quality of life.
- Hearing preservation is a key concern following VS surgery.
- Limited data exists on the predictive value of preoperative imaging for hearing outcomes.
Purpose of the Study:
- To investigate the association between cochlear magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) signal and hearing preservation after VS resection.
- To test the hypothesis that increased preoperative FLAIR signal correlates with decreased odds of hearing preservation.
Main Methods:
- Retrospective cohort study at a single academic center.
- Included patients with intracanalicular VS undergoing microsurgical resection via a middle fossa approach.
- Analyzed demographic, clinical, radiographic, and audiometric data, defining hearing preservation using AAO-HNS criteria.
Main Results:
- Twenty-seven patients were analyzed; 44.40% achieved hearing preservation (AAO-HNS class A or B) postoperatively.
- A cochlea-to-brainstem FLAIR signal ratio > 0.6 was significantly associated with decreased odds of hearing preservation (OR, 0.13; 95% CI, 0.02-0.84).
- Factors like age, sex, tumor size, and extent of resection did not correlate with hearing preservation.
Conclusions:
- Preoperative cochlear FLAIR signal intensity on MRI is a valuable imaging biomarker.
- Increased FLAIR signal predicts a lower likelihood of hearing preservation after middle fossa resection of intracanalicular VS.
- This finding can aid in surgical counseling and outcome prediction.
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