Maintaining Cochlear Patency After VIIIth Nerve Surgery
| Status: | Recruiting |
|---|---|
| Conditions: | Other Indications, Other Indications, Podiatry |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 1/16/2019 |
| Start Date: | August 4, 2017 |
| End Date: | February 1, 2021 |
| Contact: | Marianne Lahey |
| Email: | Marianne.Lahey@ascension.org |
| Phone: | 248.465.4828 |
Tumors arising from the VIIIth Nerve (vestibulo-cochlear nerve) typically present with
progressive unilateral hearing loss and tinnitus. VIIIth Nerve tumors with documented growth
on serial MRI scans typically lead to deafness in the affected ear over time. Radiation
(Gamma Knife® or stereotactic radiosurgery) may preserve hearing in ~80% while surgery
(middle cranial fossa or retrosigmoid approach) may preserve hearing in 16 - 40% of small
tumors, although initial hearing preservation by both modalities may fail over time. Surgical
resection via the translabyrinthine approach is the safest way to remove many of these
tumors, but involves loss of all hearing. In all treatment modalities, the vascular supply
(the labyrinthine artery, a terminal branch of AICA with no collaterals) to the cochlea is at
risk. After devascularization, the cochlea frequently fills with fibrous tissue or ossifies
(labyrinthitis ossificans), making it impossible to place a cochlear implant should it be
required later. The incidence of this is 46% in our patients. This study seeks to determine
the feasibility of preserving the cochlear duct with an obdurator so that patients undergoing
translabyrinthine removal of VIIIth nerve tumors may retain the option of a cochlear implant
at a later time.
progressive unilateral hearing loss and tinnitus. VIIIth Nerve tumors with documented growth
on serial MRI scans typically lead to deafness in the affected ear over time. Radiation
(Gamma Knife® or stereotactic radiosurgery) may preserve hearing in ~80% while surgery
(middle cranial fossa or retrosigmoid approach) may preserve hearing in 16 - 40% of small
tumors, although initial hearing preservation by both modalities may fail over time. Surgical
resection via the translabyrinthine approach is the safest way to remove many of these
tumors, but involves loss of all hearing. In all treatment modalities, the vascular supply
(the labyrinthine artery, a terminal branch of AICA with no collaterals) to the cochlea is at
risk. After devascularization, the cochlea frequently fills with fibrous tissue or ossifies
(labyrinthitis ossificans), making it impossible to place a cochlear implant should it be
required later. The incidence of this is 46% in our patients. This study seeks to determine
the feasibility of preserving the cochlear duct with an obdurator so that patients undergoing
translabyrinthine removal of VIIIth nerve tumors may retain the option of a cochlear implant
at a later time.
Inclusion Criteria:
- patients of all ages with unilateral or bilateral acoustic neuromas who face loss of
hearing in 1 ear from surgical removal via a translabyrinthine approach.
- patients do not meet criteria for conventional cochlear implantation or auditory
brainstem implantation.
- tumor removal must allow preservation of the auditory division of the VIIIth cranial
nerve.
- the patient must be willing to undergo preoperative S pneumococcus immunization
protocol recommended by the US CDC immunization recommendations for cochlear implant
patients.
Exclusion Criteria:
- inability to preserve the auditory division of the VIIIth cranial nerve during tumor
removal ossification or fibrosis of the cochlea found on preoperative imaging (CT or
MRI) that precludes cochlear implantation.
- active middle ear disease.
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