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Unusual acute hearing loss after gamma knife surgery for a facial schwannoma

  • Case Report - Brain Tumors
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Abstract

A 34-year-old female patient suffering from right-sided facial palsy presented to our hospital. Her hearing range was within normal limits. She had undergone GKS after receiving a diagnosis of facial nerve schwannoma (FNS). On the fourth day after GKS, the patient experienced sudden onset hearing loss on the right side without aggravation of the facial palsy. Intravenous corticosteroids were administered, and her hearing function improved gradually over the course of 15 days. This is the first case report of hyperacute hearing loss after GKS for FNS.

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Acknowledgments

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea

    Sung Ho Lee, Seok Keun Choi & Young Jin Lim

  2. Department of Neurosurgery, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea

    Hyuk Jai Choi

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  1. Sung Ho Lee
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  2. Hyuk Jai Choi
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  3. Seok Keun Choi
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  4. Young Jin Lim
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Correspondence to Young Jin Lim.

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Comment

The authors present a case of facial nerve neuroma treated with gamma knife radiosurgery, which was complicated by an early hearing impairment. They described in the report that, acknowledging the high radiation dose that would have fallen onto the cochlea, they treated it in two separate sessions. Nevertheless, after treatment of the first part, the complication arose.

As they say in their report, radiation dose to the cochlea is described as an important factor in predicting hearing preservation or loss after radiosurgery. Unfortunately, as this case so well demonstrated, it is only part of the story: the auditory nerve is also an “organ at risk”. The pattern of hearing impairment they observed after radiosurgery, with more lost in the higher frequencies, is indeed the pattern one finds in vestibular schwannomas in general, where the damage is not at all to the cochlea but to the nerve which is compressed against the inner wall of the meatus. An acute increase in the degree of this pressure can explain the early hearing loss and not necessarily radiation to the cochlea. As there was already grade 3 facial nerve weakness, there was no further deterioration, although that nerve was also compressed.

They refer in their paper to the rarity of the condition and thus this complication. Indeed, one far more commonly treats intracanalicular tumours where facial nerve function is normal and hearing is impaired, and any acute complication is facial nerve weakness. In those cases hearing is usually sufficiently poor not to worsen in this acute fashion.

Their suggestion of early treatment is eminently sensible.

Andras Kemeny

Sheffield, UK

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Lee, S.H., Choi, H.J., Choi, S.K. et al. Unusual acute hearing loss after gamma knife surgery for a facial schwannoma. Acta Neurochir 156, 397–401 (2014). https://doi.org/10.1007/s00701-013-1983-7

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  • DOI: https://doi.org/10.1007/s00701-013-1983-7

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