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. 2018 Jan;158(1):62-75.
doi: 10.1177/0194599817728878. Epub 2017 Sep 12.

Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review

Matthew Bartindale  1 , Matthew Kircher  1 , William Adams  2 , Neelam Balasubramanian  2 , Jeffrey Liles  1 , Jason Bell  1 , John Leonetti  1
Affiliations

Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review

Matthew Bartindale et al. Otolaryngol Head Neck Surg. 2018 Jan.

Abstract

Objectives (1) Determine the prevalence of hearing loss following microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS). (2) Demonstrate factors that affect postoperative hearing outcomes after MVD. Data Sources PubMed-NCBI, Scopus, CINAHL, and PsycINFO databases from 1981 to 2016. Review Methods Systematic review of prospective cohort studies and retrospective reviews in which any type of hearing loss was recorded after MVD for TN or HFS. Three researchers extracted data regarding operative indications, procedures performed, and diagnostic tests employed. Discrepancies were resolved by mutual consensus. Results Sixty-nine references with 18,233 operations met inclusion criteria. There were 7093 patients treated for TN and 11,140 for HFS. The overall reported prevalence of hearing loss after MVD for TN and HFS was 5.58% and 8.25%, respectively. However, many of these studies relied on subjective measures of reporting hearing loss. In 23 studies with consistent perioperative audiograms, prevalence of hearing loss was 13.47% for TN and 13.39% for HFS, with no significant difference between indications ( P = .95). Studies using intraoperative brainstem auditory evoked potential monitoring were more likely to report hearing loss for TN (relative risk [RR], 2.28; P < .001) but not with HFS (RR, 0.88; P = .056). Conclusion Conductive and sensorineural hearing loss are important complications following posterior fossa MVD. Many studies have reported on hearing loss using either subjective measures and/or inconsistent audiometric testing. Routine perioperative audiogram protocols improve the detection of hearing loss and may more accurately represent the true risk of hearing loss after MVD for TN and HFS.

Keywords: cerebellopontine angle; complications; hearing loss; microvascular decompression; neurotology; posterior fossa.

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Figures

Figure 1.
Figure 1.
The view the neurosurgeon has while performing a microvascular decompression in the posterior fossa. ©Jackler RK. Atlas of Skull Base Surgery and Neurotology. Stuttgart, Germany: Thieme; 2017.
Figure 2.
Figure 2.
Criteria for the National Institutes of Health’s Quality Assessment of Case Series Studies. Source: National Heart, Lung, and Blood Institute, National Institutes of Health.
Figure 3.
Figure 3.
Study selection process and reasons for exclusion. HL, hearing loss; MVD, microvascular decompression.
Figure 4.
Figure 4.
Forest plot for hearing loss in patients who underwent microvascular decompression for trigeminal neuralgia across all studies.
Figure 5.
Figure 5.
Forest plot for hearing loss in patients who underwent microvascular decompression for hemifacial spasm across all studies
Figure 6.
Figure 6.
Publication bias in trigeminal neuralgia studies.
Figure 7.
Figure 7.
Publication bias in hemifacial spasm studies.
See this image and copyright information in PMC

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