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Hearing preservation after surgical removal of acoustic neuroma- an overview
18 April 2018 (online)
Hearing loss is a common complication of acoustic neuroma (AN) surgery. Aim of the study was to evaluate the postoperative hearing preservation and its factors of influences.
In the period from march 2014 to october 2017 an AN removal was performed in 97 patients. Exclusion criteria were pretherapy, incomplete tumor resection, preoperative surditas and the diagnosis of neurofibromatosis. The postoperative hearing was checked against gender, age at surgery, preoperative hearing, kind of approach and tumor size. According to the pure-tone average (PTA) and the speech discrimination (SD) there were calssified four categories: I: PTA < 30dB; SD > 70%, II: 30dB < PTA < 60dB; 50% <SD < 70%, III: 60dB < PTA < 90dB; SD < 50% und IV: PTA > 90dB.
Besides preserving the vestibulocochlear nerve per se, the integrity of the A. labyrinthi is of crucial importance for hearing preservation. That's why Indocyanine green (ICG) was applied to some patients for visualizing the microvascuarisation.
There were 66 patientes included. 8 of them (12%) administered ICG intraoperatively.
Hearing preservation depends on hearing status and the tumor size. Postoperatively hearing loss seems to decrease by intraoperatively ICG substitution.
Hearing loss is still a commen complication after AN removal besides optimizing microsergery techniques. Intraoperatively ICG substitution seems to increase hearing preservation. Furthermore the range of side effects of ICG substitution is manageable. We suggest to use fluorescent dyes such as ICG in surgical removal of AN.