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Infrared videoangiographic assessment of cochlear nerve vasculature during middle fossa surgery
Author(s) -
Bonne NicolasXavier,
Risoud Michaël,
Wilkinson Eric P.,
Aboukais Rabih,
Baroncini Marc,
Lejeune JeanPaul,
Vincent Christophe
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25859
Subject(s) - neurotology , otology , medicine , university hospital , ophthalmology , surgery , otorhinolaryngology , head and neck surgery
Hearing preservation in the surgery of intracanalicular vestibular schwannomas (VS) using a middle fossa craniotomy (MFC) approach is achieved in up to 75% of attempted cases. Failure to maintain any hearing is easily explained when the cochlear nerve is injured during surgery. Injury may occur secondary to stretching, cautery, or section; it is more frequent when the interface between the tumor and the cochlear nerve is corrupted—or when the tumor extends to the cochlear aperture located at the lateral end of the fundus where the nerve fibers split to progress through the modiolus. Indeed, proper selection of patients, including a cochlear aperture free of tumor on preoperative magnetic resonance scan, could improve the outcomes. The use of a reliable intraoperative auditory monitoring is also associated with increasing the rate of preservation. However, there are remaining cases when the mechanism by which hearing loss occurs cannot be identified. For these situations, implication of the cochlear vasculature (e.g., vasospasm) has been proposed. Indocyanine green (ICG) is a fluorescent nearinfrared dye approved by the U.S. Food and Drug Administration for angiography (1956: cardiac function; 1975: ophthalmic angiography). Recently, its indication was extended to intracranial surgery (e.g., intracranial aneurysm, bypass, arteriovenous malformation, and meningioma surgeries). Indocyanine green fluorescence videoangiography is now widely used in neurosurgery for the intraoperative assessment of vessel patency. We applied the use of intraoperative ICG videoangiography to describe the common cochlear artery pattern and patency during the removal of intracanalicular VS.