Simultaneous cochlear implantation during retrosigmoid resection of a large vestibular schwannoma under continuous electrically evoked auditory brainstem response monitoring.
Kohei Kanaya, Ayana Imai, Hidekane Yoshimura et al.
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Case in brief
A 70-year-old woman with a 30-mm Koos grade 4 vestibular schwannoma and profound contralateral hearing loss underwent simultaneous cochlear implantation during retrosigmoid resection. Continuous intraoperative electrically evoked auditory brainstem response monitoring was utilized, allowing for subtotal tumor removal while preserving facial nerve function. Postoperatively, the cochlear implant was activated, achieving aided thresholds of 35-40 dB HL at three months, with stable tumor status at nine months.
What made this case unusual
This case is notable for the simultaneous cochlear implantation during the retrosigmoid resection of a large vestibular schwannoma, a procedure rarely reported in the literature.
Diagnostic / clinical pearl
In cases of large vestibular schwannomas, preserving electrically evoked auditory brainstem response signals can guide safe resection and facilitate hearing rehabilitation.
Why it matters
This case highlights the potential for interdisciplinary collaboration to extend hearing preservation strategies to patients with large vestibular schwannomas, previously deemed unsuitable for such interventions.