TY - JOUR
T1 - How Well Does Intraoperative Audiologic Monitoring Predict Hearing Outcome during Middle Fossa Vestibular Schwannoma Resection?
AU - Sun, Daniel Q.
AU - Sullivan, C. Blake
AU - Kung, Raymond W.
AU - Asklof, Megan
AU - Hansen, Marlan R.
AU - Gantz, Bruce J.
N1 - Publisher Copyright:
© 2018, Otology & Neurotology, Inc.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Objective: To evaluate the association between signal changes during intraoperative audiologic monitoring and postoperative audiometric outcome in patients undergoing vestibular schwannoma (VS) resection via middle cranial fossa (MCF) approach. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: One hundred twenty-six consecutive patients (mean age 48.6 yrs, range 16-67; mean tumor size 9.9 mm, range 1.8-18.9 mm) who underwent MCF VS resection. Interventions: Intraoperative audiologic monitoring using auditory brainstem response (ABR) and direct cochlear nerve action potential (CNAP). Main Outcome Measures: Intraoperative ABR wave V and CNAP N1 amplitudes and postoperative pure-tone average (PTA) and word recognition score (WRS). Results: On ABR, absent wave V amplitude was associated with an 81.1% increase and 82.3% decrease in postoperative PTA and WRS, respectively. On CNAP, decreased or absent N1 amplitude was associated with 47.3 and 100% increase, respectively, in postoperative PTA, and 45.3% and 100% decrease, respectively, in postoperative WRS. Receiver-operating curve analysis showed that ABR combined with CNAP using a Cueva electrode achieved the highest diagnostic accuracy in predicting postoperative hearing decline when measured by WRS class (sensitivity 83.3%, specificity 100%), and performed better compared with each modality alone. Conclusion: Intraoperative ABR wave V and CNAP amplitude changes are associated with changes in postoperative hearing, and dual modality monitoring was more diagnostic of postoperative hearing decline compared with each modality alone during MCF VS resection. Overall, intraoperative ABR and CNAP were more specific than sensitive for postoperative hearing decline.
AB - Objective: To evaluate the association between signal changes during intraoperative audiologic monitoring and postoperative audiometric outcome in patients undergoing vestibular schwannoma (VS) resection via middle cranial fossa (MCF) approach. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: One hundred twenty-six consecutive patients (mean age 48.6 yrs, range 16-67; mean tumor size 9.9 mm, range 1.8-18.9 mm) who underwent MCF VS resection. Interventions: Intraoperative audiologic monitoring using auditory brainstem response (ABR) and direct cochlear nerve action potential (CNAP). Main Outcome Measures: Intraoperative ABR wave V and CNAP N1 amplitudes and postoperative pure-tone average (PTA) and word recognition score (WRS). Results: On ABR, absent wave V amplitude was associated with an 81.1% increase and 82.3% decrease in postoperative PTA and WRS, respectively. On CNAP, decreased or absent N1 amplitude was associated with 47.3 and 100% increase, respectively, in postoperative PTA, and 45.3% and 100% decrease, respectively, in postoperative WRS. Receiver-operating curve analysis showed that ABR combined with CNAP using a Cueva electrode achieved the highest diagnostic accuracy in predicting postoperative hearing decline when measured by WRS class (sensitivity 83.3%, specificity 100%), and performed better compared with each modality alone. Conclusion: Intraoperative ABR wave V and CNAP amplitude changes are associated with changes in postoperative hearing, and dual modality monitoring was more diagnostic of postoperative hearing decline compared with each modality alone during MCF VS resection. Overall, intraoperative ABR and CNAP were more specific than sensitive for postoperative hearing decline.
KW - Auditory brainstem response
KW - Cochlear nerve action potential
KW - Hearing preservation
KW - Middle cranial fossa
KW - Vestibular schwannoma
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U2 - 10.1097/MAO.0000000000001859
DO - 10.1097/MAO.0000000000001859
M3 - Article
C2 - 29912825
AN - SCOPUS:85050116774
SN - 1531-7129
VL - 39
SP - 908
EP - 915
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 7
ER -