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  • Journal of Neurosurgery Publishing Group (JNSPG)  (7)
  • Bischoff, Barbara  (7)
  • 1
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    Stability of hearing preservation and regeneration capacity of the cochlear nerve following vestibular schwannoma surgery via a retrosigmoid approach
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2016
    In:  Journal of Neurosurgery Vol. 125, No. 5 ( 2016-11), p. 1277-1282
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 125, No. 5 ( 2016-11), p. 1277-1282
    Abstract: The purpose of this research was to examine the stability of long-term hearing preservation and the regeneration capacity of the cochlear nerve following vestibular schwannoma (VS) surgery in a prospective study. METHODS A total of 112 patients were recruited for a randomized multicenter trial between January 2010 and April 2012 to investigate the efficacy of prophylactic nimodipine treatment versus no prophylactic nimodipine treatment in VS surgery. For the present investigation, both groups were pooled to compare hearing abilities in the early postoperative course and 1 year after the surgery. Hearing was examined using pure-tone audiometry with speech discrimination, which was performed preoperatively, in the early postoperative course, and 12 months after surgery and was subsequently classified by an independent otorhinolaryngologist using the Gardner-Robertson classification system. RESULTS Hearing abilities at 2 time points were compared by evaluation in the early postoperative course and 1 year after surgery in 102 patients. The chi-square test showed a very strong association between the 2 measurements in all 102 patients (p 〈 0.001) and in the subgroup of 66 patients with a preserved cochlear nerve (p 〈 0.001). CONCLUSIONS There is no significant change in cochlear nerve function between the early postoperative course and 1 year after VS surgery. The result of hearing performance, as evaluated by early postoperative audiometry after VS surgery, seems to be a reliable prognosticator for future hearing ability. Clinical trial registration nos.: 2009-012088-32 ( clinicaltrialsregister.eu ) and DRKS 00000328 (“AkNiPro,” drks-neu.uniklinik-freiburg.de/drks_web/ )
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2015.10.JNS15926
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2016
    detail.hit.zdb_id: 2026156-1
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  • 2
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    A critical comparison between the semisitting and the supine positioning in vestibular schwannoma surgery: subgroup analysis of a randomized, multicenter trial
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2020
    In:  Journal of Neurosurgery Vol. 133, No. 1 ( 2020-07), p. 249-256
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 133, No. 1 ( 2020-07), p. 249-256
    Abstract: Patient positioning in vestibular schwannoma (VS) surgery is a matter of ongoing discussion. Factors to consider include preservation of cranial nerve functions, extent of tumor resection, and complications. The objective of this study was to determine the optimal patient positioning in VS surgery. METHODS A subgroup analysis of a randomized, multicenter trial that investigated the efficacy of prophylactic nimodipine in VS surgery was performed to investigate the impact of positioning (semisitting or supine) on extent of resection, functional outcomes, and complications. The data of 97 patients were collected prospectively. All procedures were performed via a retrosigmoid approach. The semisitting position was chosen in 56 patients, whereas 41 patients were treated while supine. RESULTS Complete resection was obtained at a higher percentage in the semisitting as compared to the supine position (93% vs 73%, p = 0.002). Logistic regression analysis revealed significantly better facial nerve function in the early postoperative course in the semisitting group (p = 0.004), particularly concerning severe facial nerve paresis (House-Brackmann grade IV or worse; p = 0.002). One year after surgery, facial nerve function recovered. However, there was still a tendency for better facial nerve function in the semisitting group (p = 0.091). There were no significant differences between groups regarding hearing preservation rates. Venous air embolism with the necessity to terminate surgery occurred in 2 patients in the semisitting position (3.6%). Supplementary analysis with a 2-tailed permutation randomization with 10,000 permutations of treatment choice and a propensity score matching showed either a tendency or significant results for better facial nerve outcomes in the early postoperative course and extent of resection in the semisitting group. CONCLUSIONS Although the results of the various statistical analyses are not uniform, the data indicate better results concerning both a higher rate of complete removal (according to the intraoperative impression of the surgeon) and facial nerve function after a semisitting as compared to the supine position. These advantages may justify the potential higher risk for severe complications of the semisitting position in VS surgery. The choice of positioning has to consider all individual patient parameters and risks carefully.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2019.1.JNS181784
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2020
    detail.hit.zdb_id: 2026156-1
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  • 3
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    Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2016
    In:  Journal of Neurosurgery Vol. 124, No. 3 ( 2016-03), p. 657-664
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 124, No. 3 ( 2016-03), p. 657-664
    Abstract: A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1–2 mg/hr) and hydroxyethyl starch (hematocrit 30%–35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group] ) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group] ) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34–3.43] , p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18–1.30], p = 0.15). Apart from dose-dependent hypotension (p 〈 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2015.1.JNS142001
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2016
    detail.hit.zdb_id: 2026156-1
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  • 4
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    Prophylactic nimodipine treatment and improvement in hearing outcome after vestibular schwannoma surgery: a combined analysis of a randomized, multicenter, Phase III trial and its pilot study
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2017
    In:  Journal of Neurosurgery Vol. 127, No. 6 ( 2017-12), p. 1376-1383
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 127, No. 6 ( 2017-12), p. 1376-1383
    Abstract: In clinical routines, neuroprotective strategies in neurosurgical interventions are still missing. A pilot study (n = 30) and an analogously performed Phase III trial (n = 112) pointed to a beneficial effect of prophylactic nimodipine and hydroxyethyl starch (HES) in vestibular schwannoma (VS) surgery. Considering the small sample size, the data from both studies were pooled. METHODS The patients in both investigator-initiated studies were assigned to 2 groups. The treatment group (n = 70) received parenteral nimodipine (1–2 mg/hour) and HES (hematocrit 30%–35%) from the day before surgery until the 7th postoperative day. The control group (n = 72) was not treated prophylactically. Facial and cochlear nerve functions were documented preoperatively, during the inpatient care, and 1 year after surgery. RESULTS Pooled raw data were analyzed retrospectively. Intent-to-treat analysis revealed a significantly lower risk for hearing loss (Class D) 12 months after surgery in the treatment group compared with the control group (OR 0.46, 95% CI 0.22–0.97; p = 0.04). After exclusion of patients with preoperative Class D hearing, this effect was more pronounced (OR 0.38, 95% CI 0.17–0.83; p = 0.016). Logistic regression analysis adjusted for tumor size showed a 4 times lower risk for hearing loss in the treatment group compared with the control group (OR 0.25, 95% CI 0.09–0.63; p = 0.003). Facial nerve function was not significantly improved with treatment. Apart from dose-dependent hypotension (p 〈 0.001), the study medication was well tolerated. CONCLUSIONS Prophylactic nimodipine is safe and may be recommended in VS surgery to preserve hearing. Prophylactic neuroprotective treatment in surgeries in which nerves are at risk seems to be a novel and promising concept. Clinical trial registration no.: DRKS 00000328 ( https://drks-neu.uniklinik-freiburg.de/drks_web/ )
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2016.8.JNS16626
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2017
    detail.hit.zdb_id: 2026156-1
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  • 5
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    Hearing preservation in medial vestibular schwannomas
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2008
    In:  Journal of Neurosurgery Vol. 109, No. 1 ( 2008-07), p. 70-76
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 109, No. 1 ( 2008-07), p. 70-76
    Abstract: Vestibular schwannomas (VSs) with no or little extension into the internal auditory canal have been addressed as a clinical subentity carrying a poor prognosis regarding hearing preservation, which is attributed to the initially asymptomatic intracisternal growth pattern. The goal in this study was to assess hearing preservation in patients who underwent surgery for medial VSs. Methods A consecutive series of 31 cases in 30 patients with medial VSs (mean size 31 mm) who underwent surgery between 1997 and 2005 via a suboccipitolateral route was evaluated with respect to pre- and postoperative cochlear nerve function, extent of tumor removal, and radiological findings. Intraoperative monitoring of brainstem auditory evoked potentials was performed in all patients with hearing. Patients were reevaluated at a mean of 30 months following surgery. Results Preoperative hearing function revealed American Academy of Otolaryngology–Head and Neck Surgery Foundation Classes A and B in 7 patients each, Class C in 4, and D in 9. Four patients presented with deafness. Hearing preservation was achieved in 10 patients (Classes A–C in 2 patients each, and Class D in 4 patients). Tumor removal was complete in all patients with hearing preservation, except for 2 patients with neurofibromatosis. In 4 patients a planned subtotal excision was performed due to the individual's age or underlying disease. In 1 patient a recurrent tumor was completely removed 3 years after the initial procedure. Conclusions The cochlear nerve in medial VSs requires special attention due to the atypical intracisternal growth pattern. Even in large tumors, hearing could be preserved in 37% of cases, since the cochlear nerve in medial schwannomas may not exhibit the adherence to the tumor capsule seen in tumors with comparable size involving the internal auditory canal.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/JNS/2008/109/7/0070
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2008
    detail.hit.zdb_id: 2026156-1
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  • 6
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    Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2007
    In:  Journal of Neurosurgery Vol. 107, No. 6 ( 2007-12), p. 1154-1163
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 107, No. 6 ( 2007-12), p. 1154-1163
    Abstract: In this paper, the authors introduce a method of noninvasive anatomical analysis of the facial nerve–vestibulocochlear nerve complex and the depiction of the variable vascular relationships by using 3D volume visualization. With this technique, a detailed spatial representation of the facial and vestibulocochlear nerves was obtained. Patients with hemifacial spasm (HFS) resulting from neurovascular compression (NVC) were examined. Methods A total of 25 patients (13 males and 12 females) with HFS underwent 3D visualization using magnetic resonance (MR) imaging with 3D constructive interference in a steady state (CISS). Each data set was segmented and visualized with respect to the individual neurovascular relationships by direct volume rendering. Segmentation and visualization of the facial and vestibulocochlear nerves were performed with reference to their root exit zone (REZ), as well as proximal and distal segments including corresponding blood vessels. The 3D visualizations were interactively compared with the intraoperative situation during microvascular decompression (MVD) to verify the results with the observed microneurosurgical anatomy. Results Of the 25 patients, 20 underwent MVD (80%). Microvascular details were recorded on the affected and unaffected sides. On the affected sides, the anterior inferior cerebellar artery (AICA) was the most common causative vessel. The posterior inferior cerebellar artery, vertebral artery, internal auditory artery, and veins at the REZ of the facial nerve (the seventh cranial nerve) were also found to cause vascular contacts to the REZ of the facial nerve. In addition to this, the authors identified three distinct types of NVC within the REZ of the facial nerve at the affected sides. The authors analyzed the varying courses of the vessels on the unaffected sides. There were no bilateral clinical symptoms of HFS and no bilateral vascular compression of the REZ of the facial nerve. The authors discovered that the AICA is the most common vessel that interferes with the proximal and distal portions of the facial nerve without any contact between vessels and the REZ of the facial nerve on the unaffected sides. Conclusions Three-dimensional visualization by direct volume rendering of 3D CISS MR imaging data offers the opportunity of noninvasive exploration and anatomical categorization of the facial nerve–vestibulocochlear nerve complex. Furthermore, it proves to be advantageous in establishing the diagnosis and guiding neurosurgical procedures by representing original MR imaging patient data in a 3D fashion. This modality provides an excellent overview of the entire neurovascular relationship of the cerebellopontine angle in each case.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/JNS-07/12/1154
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2007
    detail.hit.zdb_id: 2026156-1
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  • 7
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    Vasoactive treatment for hearing preservation in acoustic neuroma surgery
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2001
    In:  Journal of Neurosurgery Vol. 95, No. 5 ( 2001-11), p. 771-777
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 95, No. 5 ( 2001-11), p. 771-777
    Abstract: Object. Delayed hearing loss following surgery for acoustic neuroma indicates anatomical and functional preservation of the cochlear nerve and implies that a pathophysiological mechanism is initiated during surgery and continues thereafter. Intraoperative brainstem auditory evoked potentials (BAEPs) typically demonstrate gradual reversible loss of components in these patients. Methods. Based on this BAEP pattern, a consecutive series of 41 patients with unilateral acoustic neuromas was recruited into a prospective randomized study to investigate hearing outcomes following the natural postoperative course and recuperation after vasoactive medication. Both groups were comparable in patient age, tumor size, and preoperative hearing level. Twenty patients did not receive postoperative medical treatment. In 70% of these patients anacusis was documented and in 30% hearing was preserved. Twenty-one patients were treated with hydroxyethyl starch and nimodipine for an average of 9 days. In 66.6% of these patients hearing was preserved and in 33.3% anacusis occurred. Conclusions. These results are statistically significant (p 〈 0.05, χ 2 = 5.51) and provide evidence that these surgically treated patients suffer from a disturbed microcirculation that causes delayed hearing loss following removal of acoustic neuromas.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2001.95.5.0771
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2001
    detail.hit.zdb_id: 2026156-1
    Location Call Number Limitation Availability
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