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Intraoperative Loss of Auditory Function Relieved By Microvascular Decompression of the Cochlear Nerve

Published online by Cambridge University Press:  05 August 2019

John B. Wahlig ,
Anthony M. Kaufmann ,
Jeffrey Balzer ,
Thomas J. Lovely  and
Peter J. Jannetta
John B. Wahlig
Affiliation:
Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
Anthony M. Kaufmann*
Affiliation:
Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
Jeffrey Balzer
Affiliation:
Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
Thomas J. Lovely
Affiliation:
Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
Peter J. Jannetta
Affiliation:
Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania
*
Department of Clinical Neurosciences, University of Calgary, 12th Floor, Foothills Hospital, 1403 - 29th Street N.W., Calgary, Alberta, Canada T2N 2T9
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Abstract:

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Background:

Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve.

Methods:

Intra-operative BAEP were monitored in a consecutive series of over 300 microvascu-lar decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura.

Results:

The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss.

Conclusion:

These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. Awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.

Résumé:

Résumé:<span class='italic'>Introduction:</span>

Les potentiels évoqués auditifs du tronc cérébral (PÉATC) sont des indicateurs de la fonction auditive qui sont utiles pendant la chirurgie de la fosse postérieure. Une lésion du nerf cochléaire peut survenir par différents mécanismes et une perte complète des PÉATC est souvent associée à une perte auditive postopératoire. Nous rapportons deux cas de perte auditive peropératoire reliée à une compression vasculaire du nerf cochléaire.

<span class='italic'>Méthodes:</span>

Les PÉATC ont été surveillés peropératoire dans une série consécutive de plus de 300 décompressions microvasculaires (DMV) effectuées sur une période de 12 mois récemment. Chez deux patients qui subissaient un traitement pour névralgie du trijumeau, les ondes ont disparu complètement pendant la fermeture de la dure-mère.

<span class='italic'>Résultats:</span>

L'angle ponto-cérébelleux a été réexploré immédiatement. Il n'y avait par d'évidence d'hémorragie ou d'oedème cérébelleux. Le nerf cochléaire et le tronc cérébral ont été inspectés et une compression vasculaire évidente a été identifiée chez les deux patients. Une DMV du nerf cochléaire a provoqué une restauration immédiate des PÉATC et les deux patients ont récupéré sans perte auditive.

<span class='italic'>Conclusion:</span>

Ces cas illustrent qu'une compression vasculaire du nerf cochléaire peut affecter sa fonction et qu'elle est réversible par DMV. La connaissance de cette complication et l'observation des changements des PÉATC alertent le neurochirurgien à une cause réversible potentielle de perte auditive pendant la chirurgie de la fosse postérieure.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 1 , February 1999 , pp. 44 - 47
Copyright
Copyright © The Canadian Journal of Neurological 1999

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