Modified translabyrinthine approach and hearing preservation

Abstract

Objectives/hypothesis: In 1991, the translabyrinthine approach was modified by sealing the vestibule with bone wax, which allowed preservation of the hearing function in one patient. The present study aimed specifically at evaluating the effectiveness of the modified translabyrinthine approach in preserving hearing function in a group of patients with vestibular schwannoma that involved the internal auditory canal.

Study design: Prospective study.

Methods: The series consisted of 12 patients with vestibular schwannoma (average age, 49.7 y). The schwannoma was smaller than 2 cm in all patients who had surgery. The patients accepted for the study were required to have preserved hearing function.

Results: None of the patients has shown signs of persistence or tumoral relapse on postoperative magnetic resonance imaging. Immediately after surgery, the entire group had excellent facial functionality. Six patients had maintained their hearing function (four in Class 1 and two in Class 2 according to the Gardner-Robertson scale) at the last follow-up after surgery. A patient during follow-up noted fluctuating hearing contemporarily with a tinnitus in the ear that had maintained its hearing, which was attributable to an endolymphatic hydrops. Three of the six patients with preserved hearing complained of persistent tinnitus. None of the patients had any of the complications or consequences of cerebellopontine surgery.

Conclusion: In our patients, Class 1 or 2 hearing was preserved in 50% of the patients, with no persistence or tumoral relapse. The follow-up has obviously been short, but the first results are encouraging and deserve to be studied further in a more comprehensive survey.