VIIIth Nerve Research Articles

Central projections of auditory nerve fibers in the western rat snake (Pantherophis obsoletus).

Despite the absence of tympanic middle ears, snakes can hear. They are thought to primarily detect substrate vibration via connections between the lower jaw and the inner ear. We used the western rat snake (Pantherophis obsoletus) to determine how vibration is processed in the brain. We measured vibration-evoked potential recordings to reveal sensitivity to low-frequency vibrations. We then used tract tracing combined with immunohistochemistry and Nissl staining to describe the central projections of the papillar branch of the VIIIth nerve. Applications of biotinylated dextran amine to the basilar papilla (homologous to the organ of Corti of mammals) labeled bouton-like terminals in two first-order cochlear nuclei, a rostrolateral nucleus angularis (NA) and a caudomedial nucleus magnocellularis (NM). NA formed a distinct dorsal eminence, consisted of heterogenous cell types, and was parvalbumin positive. NM was smaller and poorly separated from the surrounding vestibular nuclei. NM was distinguished by positive calbindin label and included fusiform and round cells. Thus, the atympanate western rat snake shares similar first-order projections to tympanate reptiles. Auditory pathways may be used for detecting vibration, not only in snakes but also potentially in atympanate early tetrapods.

The Neural Basis for Biased Behavioral Responses Evoked by Galvanic Vestibular Stimulation in Primates.

Noninvasive electrical stimulation of the vestibular system in humans has become an increasingly popular tool with a broad range of research and clinical applications. However, common assumptions regarding the neural mechanisms that underlie the activation of central vestibular pathways through such stimulation, known as galvanic vestibular stimulation (GVS), have not been directly tested. Here, we show that GVS is encoded by VIIIth nerve vestibular afferents with nonlinear dynamics that differ markedly from those predicted by current models. GVS produced asymmetric activation of both semicircular canal and otolith afferents to the onset versus offset and cathode versus anode of applied current, that in turn produced asymmetric eye movement responses in three awake-behaving male monkeys. Additionally, using computational methods, we demonstrate that the experimentally observed nonlinear neural response dynamics lead to an unexpected directional bias in the net population response when the information from both vestibular nerves is centrally integrated. Together our findings reveal the neural basis by which GVS activates the vestibular system, establish that neural response dynamics differ markedly from current predictions, and advance our mechanistic understanding of how asymmetric activation of the peripheral vestibular system alters vestibular function. We suggest that such nonlinear encoding is a general feature of neural processing that will be common across different noninvasive electrical stimulation approaches.SIGNIFICANCE STATEMENT Here, we show that the application of noninvasive electrical currents to the vestibular system (GVS) induces more complex responses than commonly assumed. We recorded vestibular afferent activity in macaque monkeys exposed to GVS using a setup analogous to human studies. GVS evoked notable asymmetries in irregular afferent responses to cathodal versus anodal currents. We developed a nonlinear model explaining these GVS-evoked afferent responses. Our model predicts that GVS induces directional biases in centrally integrated head motion signals and establishes electrical stimuli that recreate physiologically plausible sensations of motion. Altogether, our findings provide new insights into how GVS activates the vestibular system, which will be vital to advancing new clinical and biomedical applications.

Geniculate Neuralgia: A Case Report and Systematic Review

BACKGROUND AND IMPORTANCE: Geniculate neuralgia (GN) is a rare disorder characterized by brief paroxysms of pain felt deeply in the auditory canal, like shock. The diagnosis of GN is essentially clinical and requiring the exclusion of other causes. The aim of this study was to report a case of surgical treatment of the disease and perform a systematic review of surgical treatment options. CLINICAL PRESENTATION: A 62-year-old female patient has had severe, sharp pain in her left ear—like an ice pick—for the past 8 months, without any history of trauma or infection. She had triggers for pain, such as talking or swallowing. Imaging investigation showed a vessel touching VIIth and VIIIth nerves, possibly the anterior inferior cerebellar artery. After finding a clinical presentation compatible with GN, treatment with anticonvulsants, gabapentinoids, and opioids was attempted, but without success with such conservative treatments. Therefore, we opted for microvascular decompression and section of the nervus intermedius, which were performed without complications. Neurophysiological assessment was essential to monitor the long tracts and stimulate VIIth and VIIIth nerves to help identify the intermediate nerve. After the procedure, the patient was without pain, and after 12 months of follow-up, she remains without any pain. CONCLUSION: Surgical treatment of GN might be beneficial when medical treatment has not worked. Cranial nerves neurophysiological monitoring is not routinely performed, and the identification is based on anatomy. A more comprehensive knowledge of this condition will help in the surgical treatment choice and in achieving better results.

Calretinin Immunoreactivity in the VIIIth Nerve and Inner Ear Endorgans of Ranid Frogs.

Calcium-binding proteins are essential for buffering intracellular calcium concentrations, which are critical for regulating cellular processes involved in neuronal computations. One such calcium-binding protein, calretinin, is present in many neurons of the central nervous system as well as those which innervate cranial sensory organs, although often with differential distributions in adjacent cellular elements. Here, we determined the presence and distribution of calretinin-immunoreactivity in the peripheral vestibular and auditory system of ranid frogs. Calretinin-immunoreactivity was observed in ganglion cells innervating the basilar and amphibian papilla, and in a subpopulation of ganglion cells innervating the saccular epithelium. In contrast, none of the ganglion cells innervating the lagena, the utricle, or the three semicircular canals were calretinin-immunopositive, suggesting that this calcium-binding protein is a marker for auditory but not vestibular afferent fibers in the frog. The absence of calretinin in vestibular ganglion cells corresponds with the lack of type I hair cells in anamniote vertebrates, many of which in amniotes are contacted by the neurites of large, calyx-forming calretinin-immunopositive ganglion cells. In the sensory epithelia of all endorgans, the majority of hair cells were strongly calretinin-immunopositive. Weakly calretinin-immunopositive hair cells were distributed in the intermediate region of the semicircular canal cristae, the central part of the saccular macula, the utricular, and lagenar striola and the medial part of the amphibian papilla. The differential presence of calretinin in the frog vestibular and auditory sensory periphery might reflect a biochemical feature related to firing patterns and frequency bandwidths of self-motion versus acoustic stimulus encoding, respectively.

Cervical and ocular vestibular evoked myogenic potentials in determining nerve division involvement in patients with a tumor located in the internal auditory canal

ObjectivesThe study aimed at the analysis of the parameters of acoustic cervical and ocular vestibular evoked myogenic potentials (AC-cVEMP and AC-oVEMP) response in patients with a confirmed tumor located in the internal auditory canal. It also aimed to assess to what degree a combination of these tests may be of benefit in the preoperative indication of the affected nerve division via preoperative determination whether the tumor originated from the superior or inferior division of the vestibular nerve, both divisions, or if it originated from a different nerve in the internal auditory canal. MethodsThe study group included 50 patients. Preoperative MRI scans were used to measure tumor diameter. AC-cVEMP and AC-oVEMP testing were performed before tumor resection. The surgeon was asked for a detailed description of the tumor origin. ResultsThe corrected amplitude of cVEMP was significantly lower on the tumor side than on the non-affected side and in the control group. The corrected Asymmetry Ratio (AR) of cVEMPs in patients with the tumor was significantly elevated above the reference values with the mean being 58.29% and the mean AR of oVEMPs in patients the tumor was 71.78% which made both results significantly higher than in the control group. Neither cVEMP nor oVEMP latency was significantly correlated with tumor size. Data obtained from cVEMP and oVEMP tests was an effective indicator of tumor origin in 74% of patients showing which division (or both divisions) of the VIIIth nerve was affected in comparison with information obtained from the surgeon. ConclusionsThe combined use of AC-cVEMP and AC-oVEMP tests may be useful in surgical planning in patients the tumor located in the internal auditory canal, providing a highly probable determination of the division of the affected nerve. Such information is valuable for the surgeon as it offers additional knowledge about the tumor before the procedure. cVEMP and oVEMP results may not be used as the basis for the calculation of tumor size in patients.

Acute consequences of a unilateral VIIIth nerve transection on vestibulo-ocular and optokinetic reflexes in Xenopus laevis tadpoles

Loss of peripheral vestibular function provokes severe impairments of gaze and posture stabilization in humans and animals. However, relatively little is known about the extent of the instantaneous deficits. This is mostly due to the fact that in humans a spontaneous loss often goes unnoticed initially and targeted lesions in animals are performed under deep anesthesia, which prevents immediate evaluation of behavioral deficits. Here, we use isolated preparations of Xenopus laevis tadpoles with functionally intact vestibulo-ocular (VOR) and optokinetic reflexes (OKR) to evaluate the acute consequences of unilateral VIIIth nerve sections. Such in vitro preparations allow lesions to be performed in the absence of anesthetics with the advantage to instantly evaluate behavioral deficits. Eye movements, evoked by horizontal sinusoidal head/table rotation in darkness and in light, became reduced by 30% immediately after the lesion and were diminished by 50% at 1.5 h postlesion. In contrast, the sinusoidal horizontal OKR, evoked by large-field visual scene motion, remained unaltered instantaneously but was reduced by more than 50% from 1.5 h postlesion onwards. The further impairment of the VOR beyond the instantaneous effect, along with the delayed decrease of OKR performance, suggests that the immediate impact of the sensory loss is superseded by secondary consequences. These potentially involve homeostatic neuronal plasticity among shared VOR-OKR neuronal elements that are triggered by the ongoing asymmetric activity. Provided that this assumption is correct, a rehabilitative reduction of the vestibular asymmetry might restrict the extent of the secondary detrimental effect evoked by the principal peripheral impairment.

Radiological diagnosis of the inner ear malformations in children with sensorineural hearing loss.

Malformations in either the inner ear, vestibulocochlear nerve (VIIIth) or auditory cortex of the brain can lead to congenital sensorineural hearing loss (SNHL). In most cases the underlying disorders involve the membranous labyrinth at a microscopic level and therefore radiological examinations are entirely normal. In a significant proportion however (up to 20%), there are abnormalities visualized in the inner ear and/or the VIIIth nerve; the type of abnormality is relevant for the surgical planning of a cochlear implant. Imaging and the accurate radiological identification of the affected inner ear structures therefore plays an integral role in the clinical evaluation of sensorineural hearing loss. In this pictorial review, we describe the main malformations of the inner ear in view of recent classifications and briefly explore the surgical implications.

High Resolution Computed Tomography and Magnetic Resonance Imaging in the Preoperative Assessment for Cochlear Implantation Candidacy

AbstractBackground: High Resolution Computed Tomography (HRCT) and magnetic resonance imaging are regularly used for cochlear implant preoperative evaluation for the evaluation of inner ear malformations, surgical planning, and especially the imaging of the VIIIth nerve. In children, these imaging procedures are especially important due to the high incidence of inner ear malformations.Aim of Work: To study the role of high resolution com-puted tomography and magnetic resonance imaging in clas-sifying 70 patients with profound deafness for possible absolute contraindications for surgery, relative contraindica-tions for surgery (difficult surgery) or easy surgery for cochlear implant.Subjects and Methods: We performed a cross sectional descriptive study on 70 patients with profound SNHL for possible cochlear implantation surgery followed-up by Helwan University Teaching Hospitals between January 2016 and December 2017.All patients were subjected to high resolution CT scan (64 mutlislice) and 3D T2 MRI of the temporal bone to delineate condition of the mastoid, vascular anomaly, internal auditory canal, cochlear nerve, size of the cochlea, status of the endo-and perilymphatic fluid, round window niche and variation of the facial nerve.All Patients were Classified into: Absolute contraindica-tions to cochlear implant surgery, relative contraindications to cochlear implant surgery and their complicating factor in making surgical intervention with relative difficulty, otherwise easy surgical intervention is assumed.Results: We studied a total of 70 patients with profound deafness planned for cochlear implantation surgery and our results showed 5.7% (n=4) of the study group would not benefit and cochlear implantation surgery is contraindicated for these patients as well as 41.4% (n=29) of the patients have had complicating criteria that possibly make surgical inter-vention difficult in comparison 52.9% (n=37) with anticipated straight forward surgical intervention which were statistically significant.Conclusion: The correct classification of cochlear condi-tions and a clear description of such abnormalities by means of multislice CT and 3D MRI are determining factors in the surgical planning developed by the cochlear implantation team, with direct impact on the success of the surgical inter-vention. Thus the radiologist experienced in the evaluation of the temporal bone plays a major role in the course of this disorder.

Semicircular Canal Influences on the Developmental Tuning of the Translational Vestibulo-Ocular Reflex.

Vestibulo-ocular reflexes (VORs) rely on neuronal computations that transform vestibular sensory signals into spatio-temporally appropriate extraocular motor commands. The motoneuronal discharge for contractions of the superior oblique eye muscle during linear translation derives from a utricular epithelial sector that is spatially aligned with the pulling direction of this muscle. In Xenopus laevis, the alignment is gradually achieved during larval development and requires motion-related semicircular canal afferent activity. Here, we studied the origin of semicircular canal and utricular signals responsible for the establishment and maturation of the extraocular motor response vector. Experiments were conducted on semi-intact preparations of Xenopus tadpoles before and after unilateral transection of the VIIIth nerve and in preparations of animals in which semicircular canal formation was prevented on one side by the injection of hyaluronidase into the otic capsule prior to the establishment of the tubular structures. Unilateral VIIIth nerve sections revealed that the excitation underlying the contraction of the superior oblique eye muscle during horizontal linear acceleration and clockwise/counter-clockwise roll motion derives exclusively from the utricle and the posterior semicircular canal on the ipsilateral side. In contrast, the developmental constriction of the otolith response vector depends on signals from the posterior semicircular canal on the contralateral side. These latter signals suppress directionally incorrect components that derive from the utricular sector perpendicular to the superior oblique eye muscle. This directional tuning complies with a stabilization of spatially correct utricular inputs that are aligned with the extraocular motor target muscle. In addition, misaligned signals are concurrently suppressed by semicircular canal-related commissural pathways from the contralateral side and through local interneuronal inhibitory circuits within the ipsilateral vestibular nuclei.

Hemifacial spasm associated with other cranial nerve syndromes: Literature review

Hyperactive dysfunction may affect all cranial nerves in the posterior fossa. According to literature review and personal experience, hemifacial spasm was found to be associated not only with the most frequent cranial nerve syndromes, namely: trigeminal neuralgia, vago-glossopharyngeal neuralgia or VIIIth nerve disturbances manifested by vertigo, tinnitus, hearing decrease, but also with rarer syndromes like geniculate neuralgia, masticatory spasm etc. Also, a number of publications have pointed out the relatively high incidence of the coexistence of hemifacial spasm and systemic blood hypertension; both can be cured by vascular decompression of the ventrolateral aspect of the medulla and IX-Xth route entry zone (REZ) together with the facial REZ. Even more complex clinical presentations have been encountered, corresponding to disturbances in several cranial nerve nuclei. Some could be attributed to neurovascular conflicts from elongated arteries invaginated into the brainstem, and cured by microvascular decompression surgery. When confronted with such complex, and therefore misleading, syndrome, it is advised to search for vascular conflicts at the brainstem using high-resolution MRI exploration.

Axonal Cleaved Caspase-3 Regulates Axon Targeting and Morphogenesis in the Developing Auditory Brainstem.

Caspase-3 is a cysteine protease that is most commonly associated with cell death. Recent studies have shown additional roles in mediating cell differentiation, cell proliferation and development of cell morphology. We investigated the role of caspase-3 in the development of chick auditory brainstem nuclei during embryogenesis. Immunofluorescence from embryonic days E6–13 revealed that the temporal expression of cleaved caspase-3 follows the ascending anatomical pathway. The expression is first seen in the auditory portion of VIIIth nerve including central axonal regions projecting to nucleus magnocellularis (NM), then later in NM axons projecting to nucleus laminaris (NL), and subsequently in NL dendrites. To examine the function of cleaved caspase-3 in chick auditory brainstem development, we blocked caspase-3 cleavage in developing chick embryos with the caspase-3 inhibitor Z-DEVD-FMK from E6 to E9, then examined NM and NL morphology and NM axonal targeting on E10. NL lamination in treated embryos was disorganized and the neuropil around NL contained a significant number of glial cells normally excluded from this region. Additionally, NM axons projected into inappropriate portions of NL in Z-DEVD-FMK treated embyros. We found that the presence of misrouted axons was associated with more severe NL disorganization. The effects of axonal caspase-3 inhibition on both NL morphogenesis and NM axon targeting suggest that these developmental processes are coordinated, likely through communication between axons and their targets.

Welcome Address

Retrogradely labeled neurons are observed in the central nervous system of the toad after peripheral application of peroxidase to the anterior and posterior stumps of the VIIIth nerve. These efferent vestibular neurons are localized in the brainstem only ipsilaterally to the treated nerve; they are restricted within a region close to the motor nucleus of the VIIth nerve, outside the vestibular nuclear complex, and are predominantly localized to the borders between the gray and white matter in an arrangement that seems to surround the motor nucleus of the VIIth nerve. No evidence was found for the existence of labeled Purkinje cells in the cerebellar cortex and therefore of a cerebellolabyrinthine pathway. The efferent vestibular neurons are medium-sized cells with two prominent dendrites, often oriented in a mediolateral direction. A comparative analysis between these neurons and the contiguous motoneurons of the VIIth nerve permitted differentiation of the two groups of neurons as to: (a) distribution in a mediolateral direction, (b) distribution in depth from the brainstem surface, (c) longitudinal extension in the caudorostral direction and (d) morphologic characteristics and dendritic arrangement of the neurons.

SPARCL1-containing neurons in the human brainstem and sensory ganglion

Secreted protein, acidic and rich in cysteine-like 1 (SPARCL1) is a member of the osteonectin family of proteins. In this study, immunohistochemistry for SPARCL1 was performed to obtain its distribution in the human brainstem, cervical spinal cord, and sensory ganglion. SPARCL1-immunoreactivity was detected in neuronal cell bodies including perikarya and proximal dendrites, and the neuropil. The motor nuclei of the IIIrd, Vth, VIth, VIIth, IXth, Xth, XIth, and XIIth cranial nerves and spinal nerves contained many SPARCL1-immunoreactive (-IR) neurons with medium-sized to large cell bodies. Small and medium-sized SPARCL1-IR neurons were distributed in sensory nuclei of the Vth, VIIth, VIIIth, IXth, and Xth cranial nerves. In the medulla oblongata, the dorsal column nuclei also had small to medium-sized SPARCL1-IR neurons. In addition, SPARCL1-IR neurons were detected in the nucleus of the trapezoid body and pontine nucleus within the pons and the arcuate nucleus in the medulla oblongata. In the cervical spinal cord, the ventral horn contained some SPARCL1-IR neurons with large cell bodies. These findings suggest that SPARCL1-containing neurons function to relay and regulate motor and sensory signals in the human brainstem. In the dorsal root (DRG) and trigeminal ganglia (TG), primary sensory neurons contained SPARCL1-immunoreactivity. The proportion of SPARCL1-IR neurons in the TG (mean ± SD, 39.9 ± 2.4%) was higher than in the DRG (30.6 ± 2.1%). SPARCL1-IR neurons were mostly medium-sized to large (mean ± SD, 1494.5 ± 708.3 μm2; range, 320.4–4353.4 μm2) in the DRG, whereas such neurons were of various cell body sizes in the TG (mean ± SD, 1291.2 ± 532.8 μm2; range, 209.3–4326.4 μm2). There appears to be a SPARCL1-containing sensory pathway in the ganglion and brainstem of the spinal and trigeminal nervous systems.

A rare type of tumor: orbital schwannoma. Case report and literature review

Abstract Schwannomas arise in the cells responsible for the mielinating the neurons distal to the Obersteiner-Redlich zone. Most of the intracranian Schwannomas are in the posterior fossa, developed from the VIIIth or Vth nerve stheath. The location on other cranian nerves is quite rare, only 6% of the orbital tumors being Schwannomas. We review the case of a 52 years old male patient, presenting for right eye exophthalmia and visual field deficit, diplopia due to VIth nerve paresis, and stubbing pain in the right eye, the MRI showing a tumor, located in the orbital apex displaced the globe forward and superiorly, and the optic nerve medially and superiorly. A modified lateral orbital approach was preferred. The choice of the orbitotomy allowed us to maintain the integrity of the lateral rim of the orbit without the need of a bony reconstruction at the end of the intervention, as it faced the anterior margin of the temporal muscle, covering it and not the skin over the zigomatic bone. The technical approach for orbital schwanomas should be tailored to reach the lesion through an esthetic incision and orbitotomy, immediately under the resected bone, with no need retracting the ocular globe or the vasculonervous elements in the orbit.

Early postnatal maturation in vestibulospinal pathways involved in neck and forelimb motor control.

To assess the organization and functional development of vestibulospinal inputs to cervical motoneurons (MNs), we have used electrophysiology (ventral root and electromyographic [EMG] recording), calcium imaging, trans-synaptic rabies virus (RV) and conventional retrograde tracing and immunohistochemistry in the neonatal mouse. By stimulating the VIIIth nerve electrically while recording synaptically mediated calcium responses in MNs, we characterized the inputs from the three vestibulospinal tracts, the separate ipsilateral and contralateral medial vestibulospinal tracts (iMVST/cMVST) and the lateral vestibulospinal tract (LVST), to MNs in the medial and lateral motor columns (MMC and LMC) of cervical segments. We found that ipsilateral inputs from the iMVST and LVST were differentially distributed to the MMC and LMC in the different segments, and that all contralateral inputs to MMC and LMC MNs in each segment derive from the cMVST. Using trans-synaptic RV retrograde tracing as well as pharmacological manipulation of VIIIth nerve-elicited synaptic responses, we found that a substantial proportion of inputs to both neck and forelimb extensor MNs was mediated monosynaptically, but that polysynaptic inputs were also significant. By recording EMG responses evoked by natural stimulation of the vestibular apparatus, we found that vestibular-mediated motor output to the neck and forelimb musculature became more robust during the first 10 postnatal days, concurrently with a decrease in the latency of MN discharge evoked by VIIIth nerve electrical stimulation. Together, these results provide insight into the complexity of vestibulospinal connectivity in the cervical spinal cord and a cogent demonstration of the functional maturation that vestibulospinal connections undergo postnatally. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 76: 1061-1077, 2016.

Safety of microvascular decompression for elderly patients with trigeminal neuralgia

ObjectiveThe present study compared the safety and efficacy of microvascular decompression (MVD) in groups of elderly patients and non-elderly patients with medically refractory trigeminal neuralgia (TN) and collected detailed perioperative data. MethodsRetrospective analysis of clinical data was performed in 99 patients who underwent MVD from May 2012 to June 2015. The outcome data from 27 MVD operations for 27 patients aged 70–80 years (mean 74.6 years) were compared with 72 MVD operations with 72 patients aged 25–69 years (mean 55.7 years). Preoperative comorbidities were recorded and postoperative worsening comorbidities and non-neurological complications were evaluated at discharge. Efficacy of the surgery and neurological complications were evaluated in July 2015. ResultsNo decrease in activity of daily living was found in any patient. Complete pain relief without medication was achieved in 77.8% and partial pain relief in 14.8% in the elderly group, and 83.3% and 9.7%, respectively, in the non-elderly group (p=0.750). Permanent neurological complication was not observed in the elderly group, whereas Vth nerve and VIIIth nerve complications were observed in the non-elderly group. Rates of preoperative multiple comorbidities and of cardiovascular comorbidity were significantly higher in the elderly group (p<0.01). Worsening comorbidity and new pathology at discharge were mainly hypertension in both groups, but glaucoma attack and asthma attack were observed in the elderly group. All pathologies were successfully managed. ConclusionsMVD for elderly patients with TN can be achieved safely with careful perioperative management. Information of comorbidity should be shared with all staff involved in the treatment, who should work as a team to avoid worsening comorbidity. The possibility of unpredictable events in the elderly patients should always be considered.

VIIIth nerve cavernous hemangioma mimicking a stage 1 acoustic schwannoma

ObjectiveTo report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. Methods and resultsWe report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. ConclusionsWhen considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity.

Microvascular decompression for hemifacial spasm: how can we protect auditory function?

Objective. The nerve function of the VIIIth nerve is at risk during microvascular decompression (MVD) for hemifacial spasm (HFS). Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) can be useful in decreasing the danger of hearing loss. This study assessed the intraoperative BAEP findings related to the surgical process to clarify the optimum maneuvers of MVD surgery to avoid hearing impairment. Methods. Hundred consecutive patients undergoing MVD for HFS with intraoperative BAEP monitoring were retrospectively reviewed. Patients were classified into four groups based on the greatest intraoperative latency prolongation and amplitude reduction of wave V of BAEP. Postoperative hearing function and surgical procedures including use of the brain retractor, preservation of arachnoid membrane along the VIIIth nerve, and duration of microscopic manipulation were analyzed in relation to the BAEP findings. Results. Three patients complained of hearing loss after the surgery, but two had complete recovery and only one suffered permanent moderate hearing impairment. Longer duration of microscopic manipulation and greater use of the brain retractor tended to have negative effects on the BAEP findings, whereas preservation of arachnoid membrane along the VIIIth nerve had a positive effect. Statistical analysis showed significant difference in preservation of arachnoid membrane along the VIIIth nerve in Groups 2 and 4 (p = 0.013). Conclusion. Stretching of the VIIIth nerve should be avoided to prevent postoperative hearing impairment. Adequate exposure of the lower cranial nerve roots and lateral medulla oblongata from the caudal side without using the brain retractor gives enough space for decompression with minimum stretching of the VIIIth nerve. Maximum preservation of the arachnoid membrane along the VIIIth nerve and shortening of the duration of microscopic manipulation may help in avoiding postoperative hearing impairment.

Exceptional Continuous Tinnitus in a Vascular Loop Syndrome of the VIIIth Cranial Nerve

Background: A case of tinnitus possibly due to vascular loop compression of VIIIth nerve is presented. Case presntation: A33-years old female suffers from tinnitus beginning 4 years ago. An extensive clinical and laboratory investigation did not reveal any abnormal finding except MRI signs of a vascular loop pressure of VIIIth nerve. Discussion: The medication did not help the patient and she refused to undergo surgery. We present the arguments of the causal relationship of the findings on MRI and symptoms of the patient. Conclusion: Tinnitus due to vascular pressure is a syndrome which should be considered in differential diagnosis in case of tinnitus.

Ototoxicity of Gentian Violet on the Guinea Pig Cochlea

Gentian violet (GV) is an antimicrobial and antifungal agent that has been used widely to treat intractable discharge in the ear. The purpose of this report is to warn clinicians about the ototoxic effect of GV in the middle ear. GV ototoxicity was evaluated by measuring compound action potentials (CAPs) in the VIIIth nerve in adult Hartley guinea pigs. The middle ear cavities of the animals were filled with GV solution (0.5% or 0.13%), and CAPs were measured after intervals of 5 and 30 minutes and 1, 2, 6, and 24 hours. After all measurements were completed, the temporal bones were harvested for histopathologic evaluation. Celloidin-embedded specimens were cut into 20-μm slices and examined using light microscopy. The bacteriostatic activity of GV was evaluated using a disk-diffusion assay. A 0.5% GV solution produced a mild elevation in the CAP threshold at 30 minutes, a greater reduction at 1 hour, and complete abolishment of CAP at 24 hours. A 0.13% GV solution caused mild elevation in the CAP threshold at 2 hours and severe elevation at 6 hours. Massive new bone formation was found in the middle ear cavity at 6 weeks. GV concentrations of 0.13% and 0.06% were effective against all bacteria tested, with the exception of Pseudomonas aeruginosa. Although GV has marked antibacterial and antifungal activities, its use should be limited to the external ear canal. GV exerts an ototoxic effect in a concentration- and time-dependent manner, and so the use of this drug in the middle ear cavity is not recommended.