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Criteria for preservation of vestibulocochlear nerve function during microsurgical removal of acoustic neurinomas

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Summary

A careful examination of the shape, location and course of the 8th cranial nerve in medium-sized and large tumours exhibits three distinct variants. In all cases where cochlear function was preserved, the type III variant (12%) in the cranial nerve tumour relationship was observed. The author's experience clearly indicates that, if a tumour is resected in toto, anatomical nerve continuity cannot be preserved in the type I and II variants (48%, respect. 40%). However, in the type I and II variants the patients invariably had preoperative hearing loss. The important criteria which must be considered in order to preserve cochlear function when extirpating acoustic neurinomas are an anatomically intact nerve, the origin of the tumour and its direction of spread, further more the shape, location and course of the 8th nerve components, the quality of preoperative cochlear nerve function, the patttern of vascularization of the statoacoustic nerve and the inner ear, and lastly, but not least a possible infiltration of the vestibular and/or cochlear nerves by the tumour itself. Objective hearing function could be preserved in 62% of small neurinomas (grade II) and 10% of large tumours (grades III and IV).

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References

  1. Belal A Jr, Linthicum FH Jr, House WF (1982) Acoustic tumor surgery with preservation of hearing. A histopathologic report. Am J Otol 4: 9–16

    PubMed  Google Scholar 

  2. Brackman DE (1980) Acoustic neuroma surgery: Otologic Medical Group results. In: Silverstein H, Norrell H (eds) Neurological surgery of the ear, Vol 2. Aesculapius, Birmingham, Ala, pp 248–259

    Google Scholar 

  3. Bremond G, Garcin M, Magnan J (1980) Preservation of hearing in the removal of acoustic neuroma. (“Minima” posterior approach by retrosigmoid route). J Laryngol Otol 94: 1199–1204

    PubMed  Google Scholar 

  4. Buchheit WA, Gastaldo JA (1977) The posterior fossa approach to acoustic tumors: preservation of hearing. In: Silverstein H, Norrell H (eds) Neurological surgery of the ear, Vol 1. Aesculapius, Birmingham, Ala, pp 263–266

    Google Scholar 

  5. Cohen NL (1979) Acoustic neurinoma surgery with emphasis on preservation of hearing. Laryngoscope 89: 886–896

    PubMed  Google Scholar 

  6. Cohen NL, Ransohoff J (1981) Preservation of hearing in acoustic neurinoma surgery. In: Samii M, Janetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 561–568

    Google Scholar 

  7. Eckermeier L, Pirsig W, Mueller D (1979) Histopathology of 30 non-operated acoustic schwannomas. Arch Otorhinolaryngol 222: 1–9

    Google Scholar 

  8. Fischer G, Costantini JL, Marcier P (1980) Improvement of hearing after microsurgical removal of acoustic neurinomas. Neurosurgery 7: 154–159

    PubMed  Google Scholar 

  9. Glasscock ME III, Dickins JRE, Wiet RJ (1980) Preservation of hearing in acoustic tumor surgery: middle fossa technique. In: Silverstein H, Norrell H (eds) Neurological surgery of the ear, Vol 2. Aesculapius, Birmingham, Ala, pp 284–286

    Google Scholar 

  10. Glasscock ME III, Hays JW, Miller GWet al (1978) Preservation of hearing in tumors of the internal auditory canal and cerebellopontine angle. Laryngoscope 88: 43–55

    Google Scholar 

  11. Harner SG, Laws ER Jr (1981) Posterior fossa approach for removal of acoustic neurinomas. Recent experience. Arch Otolaryngol 107: 590–593

    PubMed  Google Scholar 

  12. Koos WT, Spetzler RF, Pendl G, Perneczky A, Lang J (1985) Color atlas of microneurosurgery. Thieme, Stuttgart New York, Thieme & Stratton, New York

    Google Scholar 

  13. Koos WT, Perneczky A (1985) Suboccipital approach to acoustic neurinomas with emphasis on preservation of facial nerve and cochlear nerve function. In: Rand RW (ed) Microneurosurgery, 3rd ed. Mosby, St. Louis Toronto Princeton, pp 335–365

    Google Scholar 

  14. MacCarty CS (1975) Acoustic neuroma and the suboccipital approach (1967–1972). Mayo Clin Proc 50: 15–16

    PubMed  Google Scholar 

  15. Neely JG (1976) Gross and microscopic anatomy of the eighth cranial nerve in relationship to the solitary schwannoma. Laryngoscope 91: 1512–1531

    Google Scholar 

  16. Neely JG, Britton BH, Greenberg SD (1976) Microscopic characteristics of the acoustic tumor in relationship to its nerve of origin. Laryngoscope 86: 984–991

    PubMed  Google Scholar 

  17. Ojemann RG (1980) Comments on Fischer G, Costantini JL, Mercier P (1980) Improvement of hearing after microsurgical removal of acoustic neurinoma. Neurosurgery 7: 154–159

    PubMed  Google Scholar 

  18. Ojemann RG (1978) Microsurgical suboccipital approach to cerebellopontine angel tumors. Clin Neurosurg 25: 461–479

    PubMed  Google Scholar 

  19. Ojemann RG, Corwell RC (1978) Acoustic neuromas treated by microsurgical suboccipital operations. Prog Neurol Surg 9: 337–373

    Google Scholar 

  20. Piffko P, Pasztor E (1981) Operated bilateral acoustic neurinoma with preservation of hearing and facial nerve function. J Otorhinolaryngol 43: 255–261

    Google Scholar 

  21. Rand RW, Kurze T (1968) Preservation of vestibular, cochlear and facial nerves during microsurgical removal of acoustic tumors: report of two cases. J Neurosurg 28: 158–161

    PubMed  Google Scholar 

  22. Ransohoff J, Cohen N (1981) Total removal of acoustic neurinoma with preservation of hearing. In: Abstracts, 50th anniversary meeting, AANS, Boston, pp 44–45

    Google Scholar 

  23. Rhoton AL Jr (1976) Microsurgical removal of acoustic neuromas. Surg Neurol 6: 211–219

    PubMed  Google Scholar 

  24. Rhoton AL Jr (1985) Microsurgical anatomy of the internal acoustic meatus and facial nerve. In: Rand RW (ed) Microneurosurgery, 3rd ed. Mosby, St. Louis Toronto Princeton, pp 217–235

    Google Scholar 

  25. Samii M (1979) Operative treatment of cerebellopontine angle tumors with special consideration of the facial and the acoustic nerve. In: Marguth Fet al (eds) Advances in neurosurgery, Vol 7. Springer, Berlin, pp 138–145

    Google Scholar 

  26. Samii M, Ohlemutz A (1981) Preservation of eighth cranial nerve in cerebello-pontine angle tumors. In: Samii M, Janetto PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 586–590

    Google Scholar 

  27. Smith MFW, Clancy TP, Lang JS (1977) Conservation of hearing in acoustic neurilemmoma excision. Trans Am Acad Ophthalmol Otolaryngol 84: 704–709

    Google Scholar 

  28. Sterkers JM (1980) Removal of bilateral and unilateral acoustic tumors with preservation of hearing: a comparison of the retrosigmoid and translabyrinthine approach. In: Silverstein H, Norrell H (eds) Neurological surgery of the ear, Vol 2. Aesculapius, Birmingham, Ala, pp 269–277

    Google Scholar 

  29. Sterkers JM (1979) Neurinomas de l'acoustique et autres tumeurs de l'angle et du conduit auditif interne. Resultats operatoires et choix de la voie d'abord (126 cas.). Ann Otolaryngol Chir Cervico-fac 96: 373–386

    Google Scholar 

  30. Sterkers JM, Hamann KF (1979) The retrosigmoidal approach-a possibility to preserve hearing function in operations of acoustic neuromas. Arch Otorhinolaryngol 223: 463–465

    Google Scholar 

  31. Sterkers JM (1981) Retro-sigmoid approach for preservation of hearing in early acoustic neuroma surgery. In: Samii M, Janetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 586–590

    Google Scholar 

  32. Sugita K, Kobayashi S, Mutsuga Net al (1979) Microsurgery for acoustic neurinoma-lateral position and preservation of facial and cochlear nerves. Neurol Med Chir 19: 637–641

    Google Scholar 

  33. Wanxing C (1981) Preservation of facial and acoustic nerves in total removal of large and small acoustic tumors. Report of two cases. J Neurosurg 54: 268–272

    PubMed  Google Scholar 

  34. Yaşargil MG, Smith RD, Gasser JC (1977) Microsurgical approach to acoustic neurinomas. In: Krayenbühl H (ed) Advances and technical standards in neurosurgery, Vol 4. Springer, Wien New York, pp 93–129

    Google Scholar 

  35. Ylikoski J, Palva T, Collan Y (1978) Eighth nerve in acoustic neuromas. Arch Otolaryngol 104: 532–537

    PubMed  Google Scholar 

  36. Ylikoski Jet al (1978) Cochlear nerve in neurilemomas. Arch Otolaryngol 104: 679–684

    PubMed  Google Scholar 

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  1. Department of Neurosurgery, University of Vienna Medical School, Vienna, Austria

    W. T. Koos

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  1. W. T. Koos
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Koos, W.T. Criteria for preservation of vestibulocochlear nerve function during microsurgical removal of acoustic neurinomas. Acta neurochir 92, 55–66 (1988). https://doi.org/10.1007/BF01401974

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