Abstract
The authors present the case of a 24-year-old female with neurofibromatosis type 2. Growth of the left vestibular schwannoma and progressive hearing loss prompted the decision to proceed to translabyrinthine resection with cochlear nerve preservation and cochlear implant insertion. Complete resection with preservation of the facial and cochlear nerves was achieved. The patient had grade 1 facial function and was discharged on postoperative day 4 following suturing of a minor CSF leak. This case highlights the feasibility of cochlear nerve preservation and cochlear implant insertion in appropriately selected patients, offering a combination of effective tumor control and hearing rehabilitation.The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21122
Highlights
We present the case of a translabyrinthine resection of a neurofibromatosis type 2 (NF2)–associated vestibular schwannoma (VS) with simultaneous cochlear implant insertion
Postcontrast T1-weighted MRI demonstrated the presence of bilateral vestibular schwannomata, larger on the left side, as previously described
Stereotactic radiosurgery was considered, we elected against this approach due to the poorer tumor control in NF2-associated vestibular schwannomata as compared to sporadic tumors, the small but present risk of malignant transformation of the VS in a patient with a tumor predisposition syndrome, and the suggestion in the literature of poorer hearing outcomes associated with CI implantation in the setting of an irradiated VS.[2,3,4]
Summary
We present the case of a translabyrinthine resection of a neurofibromatosis type 2 (NF2)–associated vestibular schwannoma (VS) with simultaneous cochlear implant insertion. Slowly progressive growth was demonstrated on recent surveillance imaging, more so of the left-sided tumor. The decision to proceed with a translabyrinthine approach and resection of the tumor, with simultaneous cochlear implant insertion, was taken for a number of reasons.
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