OBJECTIVE: To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology. METHODS: The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package. RESULTS: Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031). CONCLUSION EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.
Humans ; Neuroma, Acoustic/complications* ; Electroencephalography ; Patients ; Probability

Female ; Humans ; Middle Aged ; Neuroma, Acoustic ; complications ; Subarachnoid Hemorrhage ; etiology

A retrospective analysis of 15 cases intracanalicular acoustic neuroma that undergone tumour excision by translabyrinthine approach spanning from August 1996 until December 2002 is presented. The main presenting complaints are unilateral hearing loss (100%) and tinnitus (86.7%). The mean age of presentation was 48.5 years old. Magnetic resonance imaging is the most important investigation tool to diagnose acoustic neuroma. At six months post operatively, the facial nerve was normal or near normal (grade I and II) in 46.6%, grade III to IV in 46.6% and grade V to VI in 6.7% of the cases respectively. There were also four cases of post operative cerebrospinal fluid leak, which was successfully managed with conservative measures. The translabyrinthine approach is the most familiar surgical technique employed by otologist. It is the most direct route to the cerebellopontine angle and internal auditory canal. It requires minimum cerebellar retraction. However, it sacrifices any residual hearing in the operated ear.
Neuroma, Acoustic ; Grade ; seconds ; Complications Specific to Antepartum or Postpartum ; sacrifice

BACKGROUND: Intraoperative neurophysiologic monitoring(INM) is well known to be useful method to reduce intraoperative complications during tumor surgery in cerebellopontine angle(CPA). We investigated the changes of INM during the surgery. It might be helpful to keep one's eyes on which monitoring modalities are reluctant to change during the operation. METHODS: We included 49 subjects who had undergone CPA tumor surgery under INM. Their pathology was as follows; vestibular schwannoma in 37, other cranial nerve schwannoma in 3, meningioma in 5 , cyst in 2. The modalities of monitoring were short latency auditory evoked potentials(AEP), somatosensory evoked potentials(SEP) , facial and trigeminal nerve EMG(EMG). Stimulation of SEP was on left or right median, posterior tibial nerves. We studied the frequency of abnormal INM changes and the factors affecting it. RESULTS: The subjects who had abnormal changes in at least one monitoring modality were 19(38.8.%). AEP changes were in 6.1%, SEP in 12.2% and EMG in 24.5%. The AEP monitoring had no potentials from II through V wave in 28 subjects(57.1%). SEP monitoring had improvement in 2 subjects and aggravation in 6, especially involved in median nerve SEP. Tonic EMG activities were observed in 3 facial muscles of 3 subjects, 2 of 4, 1 of 5. Regarding the pathology of tumor, meningioma had much more changed INM than vestibular schwannoma. The volume of tumor was bigger in abnormal INM group than normal group although it is not statistically significant. Also abnormal SEP and EMG group had bigger mass than normal group. CONCLUSIONS: INM has frequent electrophysiologic changes during tumor surgery in CPA. Especially EMG can be changed the most frequently. The larger tumor are, the more frequently abnormal changes in INM of CPA tumor surgery are.
Cerebellopontine Angle* ; Cranial Nerves ; Facial Muscles ; Intraoperative Complications ; Median Nerve ; Meningioma ; Monitoring, Intraoperative ; Neurilemmoma ; Neuroma, Acoustic ; Pathology ; Tibial Nerve ; Trigeminal Nerve

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (< or =1 cm), 18 were medium (1-3 cm), and 16 (45.7%) were large (>3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.
Cerebellopontine Angle ; Cranial Nerves ; Deglutition Disorders ; Facial Paralysis ; Headache ; Hearing ; Hearing Loss ; Humans ; Intracranial Hemorrhages ; Male ; Neuroma, Acoustic ; Postoperative Complications ; Retrospective Studies ; Tinnitus ; Vertigo

BACKGROUND AND OBJECTIVES: The use of several approaches, involving different cerebellopontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. SUBJECTS AND METHODS: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. RESULTS: Of the 35 patients, 12 were men and 23 women; their age was 52.5+/-10.4 years (range, 35-75 years). One tumor was small (< or =1 cm), 18 were medium (1-3 cm), and 16 (45.7%) were large (>3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5+/-4.4 mm (range 14.5-25.0 mm). CONCLUSIONS: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.
Cerebellopontine Angle ; Cranial Nerves ; Deglutition Disorders ; Facial Paralysis ; Headache ; Hearing ; Hearing Loss ; Humans ; Intracranial Hemorrhages ; Male ; Neuroma, Acoustic ; Postoperative Complications ; Retrospective Studies ; Tinnitus ; Vertigo

PURPOSE: Many epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma. MATERIALS AND METHODS: We searched PubMed to identify relevant articles. Two researchers evaluated the eligibility and extracted the data independently. RESULTS: Eleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05-1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84-1.72 and OR=1.15, 95% CI: 0.80-1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30-0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81-1.10) and 0.49 (95% CI: 0.41-0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80-1.18), 0.91 (95% CI: 0.76-1.09), and 1.52 (95% CI: 0.90-2.54), respectively. CONCLUSION: Our meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.
Adult ; Asthma/complications ; Environmental Exposure/*adverse effects ; Female ; Humans ; Hypersensitivity ; *Leisure Activities ; Neuroma, Acoustic/epidemiology/*etiology ; Noise/*adverse effects ; Occupational Exposure/adverse effects ; Risk Factors ; Smoking/adverse effects

OBJECTIVETo analyze the surgical outcomes and share experience in the surgical management of acoustic neuroma(AN).

METHODSA retrospective review was performed in 134 patients with sporadic large ANs operated from Jan. 2001 to Dec. 2012. The patients' information, tumor size, tumor cystic degeneration, surgical approach, intraoperative anatomical facial nerve integrity rate, postoperative facial nerve function and complications were recorded.

RESULTSThere were one hundred and twenty-nine patients (96.3%) received surgeries within one month after first diagnosis of vestibular schwannoma(VS) or definite diagnosis of recurrence.Five patients (3.7%) hesitated to be operated until tumor was found to be growing on MRI during the follow-up. The average tumor diameter was about (40.9 ± 6.8) mm (31.0-70.0 mm). The cystic tumor percentage arrived at 35.1% (47/134). The surgical approaches included 118(88.1%) translabyrinthine approaches, comprising 16(11.9%) modified enlarged translabyrinthine approaches, and 16 (11.9%) transaortic approaches. Total, near total, and subtotal tumor removal rate was 91.0% (122/134), 6.7% (9/134) and 2.2% (3/134), respectively. The anatomical facial nerve integrity was preserved in 88.8% (19/134) of all patients. And it was significantly lower in cystic VS (80.9% vs 93.1%, P = 0.044). There were 32.3% (43/133) and 36.8% (49/133) of patients had a good postoperative facial nerve function in short-term (discharge from hospital) and long-term (1 year) follow-up, respectively.General rate of complications was 17.9% (24/134). CSF leakage occurred in 7.5% of patients. Mortality rate was 0.7% (1/134). Follow-up time ranged from 1 to 5 years, average time was(2.7 ± 0.4)years.Four cases occurred recurrence.

CONCLUSIONSMajor management strategy of large AN is surgical resection.Even for those who had temporary antagonism for surgery, the wait and scan policy is necessary. Although the tumor removal is safe and accompanies extremely low mortality and incidence of complication, the patient with large AN must be informed in detail about the possible surgical risks. The tumor cystic degeneration is an important crucial factor which influences the surgical outcomes of AN, especially in postoperative facial nerve function.

Adolescent ; Adult ; Aged ; Child ; Ear, Inner ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; pathology ; surgery ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Young Adult

BACKGROUND AND OBJECTIVES: Acoustic tumor which originates from the vestibular nerve is the most common neoplasm to be found at the cerebellopontine angle. The surgical approaches currently used for the acoustic tumor are the middle cranial fossa, the translabyrinthine, the suboccipital, and the combined approaches depending on the size, location, and growth rate of the tumor and the hearing level, age, and general health condition of the patient. This study was performed to evaluate the results of acoustic tumor surgery. MATERIALS AND METHODS: We reviewed 12 acoustic tumor patients who were operated in the department of otolaryngology of the Severance hospital from June 1991 to December 1994. RESULTS: We could remove tumors completely except for two cases where the sizes of tumor were large. Postoperative complications were hearing loss, facial paresis, cerebral spinal fluid leakage, and intracranial hemorrhage. CONCLUSION: From our experience of acoustic tumor surgery, we could suggest the following strategy for patients with acoustic tumor: 1) Hearing preservation surgery has to be chosen in case of the intracanalicular tumor with serviceable hearing: 2) When the tumor extends to the cerebellopontine angle: functional preservation of facial nerve is the prime goal for the patients: and 3) A total removal of tumor without considering the functional preservation is not always the best method of treatment.
Acoustics* ; Cerebellopontine Angle ; Cranial Fossa, Middle ; Facial Nerve ; Facial Paralysis ; Hearing ; Hearing Loss ; Humans ; Intracranial Hemorrhages ; Neuroma, Acoustic* ; Otolaryngology ; Postoperative Complications ; Vestibular Nerve

Objective: To explore the value of electrically evoked auditory brainstem response (EABR) monitoring combined with brainstem auditory evoked potential (BAEP) and compound action potential (CAP) monitoring during vestibular schwannoma resection for the protection of the cochlear nerve. Methods: Clinical data from 12 patients with vestibular schwannomas who had useful hearing prior to surgery were analyzed at the PLA General Hospital from January to December 2021. Among them, there were 7 males and 5 females, ranging in age from 25 to 59 years. Before surgery, patients underwent audiology assessments (including pure tone audiometry, speech recognition rate, etc.), facial nerve function evaluation, and cranial MRI. They then underwent vestibular schwannoma resection via the retrosigmoid approach. EABR, BAEP, and CAP were simultaneously monitored during surgery, and patients' hearing preservation was observed and analyzed after surgery. Results: Prior to surgery, the average PTA threshold of the 12 patients ranged from11 to 49 dBHL, with a SDS of 80% to 100%. Six patients had grade A hearing, and six patients had grade B hearing. All 12 patients had House-Brackman grade I facial nerve function prior to surgery. The MRI indicated tumor diameters between 1.1 and 2.4 cm. Complete removal was achieved in 10/12 patients, while near-total removal was achieved in 2/12 patients. There were no serious complications at the one-month follow-up after surgery. At the three-month follow-up, all 12 patients had House-Brackman grade I or II facial nerve function. Under EABR with CAP and BAEP monitoring, successful preservation of the cochlear nerve was achieved in six of ten patients (2 with grade B hearing, 3 with grade C hearing, and 1 with grade D hearing). Successful preservation of the cochlear nerve was not achieved in another four patients (all with grade D hearing). In two patients, EABR monitoring was unsuccessful due to interference signals; however, Grade C or higher hearing was successfully preserved under BAEP and CAP monitoring. Conclusion: The application of EABR monitoring combined with BAEP and CAP monitoring during vestibular schwannoma resection can help improve postoperative preservation of the cochlear nerve and hearing.
Male ; Female ; Humans ; Adult ; Middle Aged ; Neuroma, Acoustic/complications* ; Hearing/physiology* ; Evoked Potentials, Auditory, Brain Stem/physiology* ; Cochlear Nerve ; Hearing Loss, Sensorineural/etiology* ; Retrospective Studies ; Postoperative Complications/prevention & control*