Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2024
Hearing Preservation and Functional Outcomes After Resection of Epidermoid Lesions of the Cerebellopontine Angle With High Hearing Risk.
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Papazian Michael, Cottrell Justin, Yang Jackie, Kay-Rivest Emily, Friedmann David R, Jethanamest Daniel, Kondziolka Douglas, Pacione Donato, Sen Chandranath, Golfinos John G, Thomas Roland J, McMenomey Sean O
Аннотация
OBJECTIVES: To assess a decade of experience of treating patients with high hearing risk cerebellopontine angle (CPA) epidermoid lesions and examine factors influencing postoperative outcomes, particularly hearing preservation.
STUDY DESIGN: Retrospective chart review.
SETTING: Single tertiary-referral center.
PATIENTS: Adults with CPA epidermoid lesions who presented with hearing loss or evidence of lesion involving vestibulocochlear nerve.
INTERVENTIONS: The studied intervention was microsurgical resection.
MAIN OUTCOME MEASURES: Main outcome measures included extent of resection, hearing preservation rate for patients with postoperative audiograms, and disease progression.
RESULTS: Twenty-three adults with an average tumor volume of 15.63 ± 16.2 cm3 were included. Five lesions (22%) involved the full internal auditory canal (IAC), 11 (48%) had partial involvement, and 5 (22%) were IAC sparing. Most patients with IAC involvement (88%) had circumferential invasion of the canal. Patients underwent either a retrosigmoid (18, 79%) or combined retrolabyrinthine transpetrosal approach (5, 22%), and gross total resection was achieved in most cases (13, 57%). Of 12 patients with postoperative audiograms, 10 (83%) had preoperative hearing preserved. There was no statistically significant change in hearing scores with treatment based on preoperative extent of IAC involvement. Ten patients (43%) had residual lesions postoperatively, and 6 exhibited progression. One patient ultimately required reoperation 6 years after initial surgery.
CONCLUSIONS: Preoperative hearing was preserved in the majority of the patients who underwent resection of CPA epidermoids via a retrosigmoid or transpetrosal approach. CPA epidermoids often invaded the IAC; however, degree of invasion was not associated with hearing outcomes.
STUDY DESIGN: Retrospective chart review.
SETTING: Single tertiary-referral center.
PATIENTS: Adults with CPA epidermoid lesions who presented with hearing loss or evidence of lesion involving vestibulocochlear nerve.
INTERVENTIONS: The studied intervention was microsurgical resection.
MAIN OUTCOME MEASURES: Main outcome measures included extent of resection, hearing preservation rate for patients with postoperative audiograms, and disease progression.
RESULTS: Twenty-three adults with an average tumor volume of 15.63 ± 16.2 cm3 were included. Five lesions (22%) involved the full internal auditory canal (IAC), 11 (48%) had partial involvement, and 5 (22%) were IAC sparing. Most patients with IAC involvement (88%) had circumferential invasion of the canal. Patients underwent either a retrosigmoid (18, 79%) or combined retrolabyrinthine transpetrosal approach (5, 22%), and gross total resection was achieved in most cases (13, 57%). Of 12 patients with postoperative audiograms, 10 (83%) had preoperative hearing preserved. There was no statistically significant change in hearing scores with treatment based on preoperative extent of IAC involvement. Ten patients (43%) had residual lesions postoperatively, and 6 exhibited progression. One patient ultimately required reoperation 6 years after initial surgery.
CONCLUSIONS: Preoperative hearing was preserved in the majority of the patients who underwent resection of CPA epidermoids via a retrosigmoid or transpetrosal approach. CPA epidermoids often invaded the IAC; however, degree of invasion was not associated with hearing outcomes.