Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation
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S. K. Plontke1 · P. Caye-Thomasen2 · C. Strauss3 · S. Kösling4 · G. Götze1 · U. Siebolts5 · D. Vordermark6 · L. Wagner1 · L. Fröhlich1 · T. Rahne1 1
© The Author(s) 2020
Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany 2 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark 3 Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany 4
Department of Radiation Medicine, Clinic for Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany 5 Institute of Pathology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany 6 Department of Radiation Medicine, Clinic for Radiotherapy, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Germany
Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation Video online The online version of this article (https:// doi.org/10.1007/s00106-020-00919-9) includes a video (2D and 3D versions) of the described surgical technique. Article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field, the supplementary material can be found under “Ergänzende Inhalte”.
Introduction Cochleovestibular schwannomas are benign tumors of the eighth cranial nerve with an incidence of approximately 3.4/105 [41]. They usually originate from the vestibular nerve and occur as uni-
lateral, sporadic, nonsyndromic tumors. Bilateral occurrence has been observed in 5–10% of cases associated with neurofibromatosis 2 (NF2) [12]. The usual tumor locations are the internal auditory canal (IAC) and the cerebellopontine angle (CPA) [27]; however, they can also occur as intralabyrinthine schwannomas (ILS) in the terminal branches of the eighth cranial nerve in the inner ear (recently reviewed in [8]). Hearing loss because of vestibular schwannomas (VS) negatively influences the quality of life and patients with this condition are increasingly interested in hearing rehabilitation with cochlear implantation (CI) [25, 28, 57]. Several case reports, case series and first systematic reviews have illustrated that after surgical removal of sporadic VS or VS associated with NF2, CI can lead to good hearing results, even though not all patients will achieve good speech understanding. The CI may be performed in one stage with tumor removal [3, 45, 50, 57] or in a second surgery [3, 4, 17, 22, 42]. Similar initial results for hearing rehabilitation
are available for CI after radiotherapy [9, 28, 31] and with a wait and test and scan strategy [5]. For ILS limited to the inner ear, surprisingly good results with CI with respect to speech understanding have been reported, despite substantial cochlear trauma from the surgical tumor removal [2, 35, 36, 38]. Special subtypes of cochleovestibula
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