European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 10, pp 2627–2635 | Cite as

Vasospasm of labyrinthine artery in cerebellopontine angle surgery: evidence brought by distortion-product otoacoustic emissions

  • Thierry Mom
  • Audrey Montalban
  • Toufic Khalil
  • Jean Gabrillargues
  • Jean Chazal
  • Laurent Gilain
  • Paul Avan
Otology

Abstract

In cerebellopontine angle (CPA) surgery, postoperative deafness can be due to alteration of cochlear blood flow that is supplied by the labyrinthine artery (LA). In particular, vasospasm is likely to occur and, if so, can be reversed. This work attempted to track down vascular events occurring during CPA surgery. Twenty consecutive patients with vestibular schwannoma were tested with useful preoperative hearing and presence of otoacoustic emissions (OAEs). Distortion-product otoacoustic emissions (DPOAEs), well-known to react within seconds to cochlear ischemia, were used intraoperatively to indirectly monitor cochlear blood flow. Continuous intraoperative monitoring of DPOAEs revealed three different time patterns associated with distinct auditory outcomes. Pattern P1-acute (n = 4) happened when the LA was severed: DPOAEs immediately and irreversibly foundered and led to postoperative deafness. Pattern P2-protracted (n = 7) revealed a progressive deterioration of DPOAEs from the beginning of tumor debulking, likely due to a steady decrease of cochlear blood flow, with postoperative deafness. Pattern P3-unstable (n = 5) corresponded to large DPOAE oscillations between their normal level and noise floor. It was due to acute LA vasospasm that could be reversed in three cases by topical nimodipin. Last, four patients had uneventful cochlear monitoring. In conclusion, cochlear ischemia can occur in vestibular schwannoma surgery, giving three different patterns among which vasospasm can be reversed if detected early.

Keywords

Vestibular schwannoma Hearing preservation Distortion-product otoacoustic emissions Cochlear ischemia 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Thierry Mom
    • 1
    • 3
  • Audrey Montalban
    • 1
  • Toufic Khalil
    • 2
  • Jean Gabrillargues
    • 4
  • Jean Chazal
    • 2
  • Laurent Gilain
    • 1
    • 3
  • Paul Avan
    • 3
  1. 1.Department of Otolaryngology Head Neck SurgeryUniversity Hospital of Clermont-FerrandClermont-FerrandFrance
  2. 2.Department of Neurosurgery AUniversity Hospital of Clermont-FerrandClermont-FerrandFrance
  3. 3.Laboratory of Neurosensory BiophysicsINSERM UMR 1107, School of Medicine, Université Clermont1Clermont-FerrandFrance
  4. 4.Department of NeuroradiologyUniversity Hospital of Clermont-FerrandClermont-FerrandFrance

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