Does a "fundal Fluid Cap" Predict Successful Hearing Preservation in Vestibular Schwannoma Resections Via the Middle Cranial Fossa Approach?

Daniel Sun, Raymond W. Kung, Marlan R. Hansen, Bruce J. Gantz

Research output: Contribution to journalArticle

Abstract

Objective: To determine the association between radiographic cerebrospinal fluid (CSF) cap in the lateral internal auditory canal (IAC) and likelihood of successful hearing preservation in middle cranial fossa (MCF) vestibular schwannoma (VS) surgery. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: One hundred thirty-eight consecutive patients (mean age/standard deviation, SD, 50/11 yr) who underwent MCF VS resection. Interventions: MCF VS excision. Main Outcome Measures: Size of fundal fluid cap on preoperative magnetic resonance imaging (MRI), pre- and postoperative pure-tone average (PTA), and word recognition score (WRS). Results: Mean tumor and fundal fluid sizes were 9.7 mm (SD, 3.9 mm) and 2.8 mm (SD, 1.7 mm), respectively. On bivariate analysis, fundal fluid size was associated with larger tumor size (p = 0.005) but not changes in postoperative PTA (p = 0.45) or WRS (p = 0.17). When fundal fluid size was stratified as none (<1 mm), small (≥1 mm and <4 mm), and large (≥4 mm), no significant differences were seen in rates of hearing preservation. Using multivariate linear regression models adjusting for patient age, sex, tumor nerve of origin, neurofibromatosis type II status, and preoperative PTA and WRS, superior vestibular nerve tumor origin but not increasing fundal fluid size was associated with preserved postoperative PTA or WRS. Conclusions: Presence or size of CSF fluid cap may not be a reliable prognostic indicator for hearing preservation in MCF VS resection, with important implications for patient counseling.

Original languageEnglish (US)
Pages (from-to)772-777
Number of pages6
JournalOtology and Neurotology
Volume39
Issue number6
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Middle Cranial Fossa
Acoustic Neuroma
Hearing
Cerebrospinal Fluid
Linear Models
Neoplasms
Neurofibromatosis 2
Vestibular Nerve
Tertiary Care Centers
Counseling
Retrospective Studies
Magnetic Resonance Imaging
Outcome Assessment (Health Care)

Keywords

  • Cerebrospinal fluid cap
  • Fundal fluid cap
  • Hearing preservation
  • Internal auditory canal
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

Does a "fundal Fluid Cap" Predict Successful Hearing Preservation in Vestibular Schwannoma Resections Via the Middle Cranial Fossa Approach? / Sun, Daniel; Kung, Raymond W.; Hansen, Marlan R.; Gantz, Bruce J.

In: Otology and Neurotology, Vol. 39, No. 6, 01.07.2018, p. 772-777.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the association between radiographic cerebrospinal fluid (CSF) cap in the lateral internal auditory canal (IAC) and likelihood of successful hearing preservation in middle cranial fossa (MCF) vestibular schwannoma (VS) surgery. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: One hundred thirty-eight consecutive patients (mean age/standard deviation, SD, 50/11 yr) who underwent MCF VS resection. Interventions: MCF VS excision. Main Outcome Measures: Size of fundal fluid cap on preoperative magnetic resonance imaging (MRI), pre- and postoperative pure-tone average (PTA), and word recognition score (WRS). Results: Mean tumor and fundal fluid sizes were 9.7 mm (SD, 3.9 mm) and 2.8 mm (SD, 1.7 mm), respectively. On bivariate analysis, fundal fluid size was associated with larger tumor size (p = 0.005) but not changes in postoperative PTA (p = 0.45) or WRS (p = 0.17). When fundal fluid size was stratified as none (<1 mm), small (≥1 mm and <4 mm), and large (≥4 mm), no significant differences were seen in rates of hearing preservation. Using multivariate linear regression models adjusting for patient age, sex, tumor nerve of origin, neurofibromatosis type II status, and preoperative PTA and WRS, superior vestibular nerve tumor origin but not increasing fundal fluid size was associated with preserved postoperative PTA or WRS. Conclusions: Presence or size of CSF fluid cap may not be a reliable prognostic indicator for hearing preservation in MCF VS resection, with important implications for patient counseling.",
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