Subtotal Cochleoectomy for Intracochlear Schwannoma Removal and Cochlear Implantation

By June 7, 2019

Plontke, Stefan K.1
1 Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany.

Intralabyrinthine schwannomas (ILS) are a special, rare form of schwannomas of the eighth cranial nerve. The different types of ILS require different management, depending on the location and extent of the tumor, and the patients’ expectations including tumor removal and hearing rehabilitation.

For removal of tumors filling the cochlea (intracochlear schwannomas) subtotal cochleoectomy is advocated. Despite subtotal cochleoectomy, cochlear implantation is possible if parts of the modiolus, carrying the spiral ganglion neurons can be preserved. With the means of a surgical video (2D /3D as requested) using a new, fully-digital microscope, we describe the removal of an intracochlear schwannoma through a subtotal cochleoctomy, cochlear defect closure and cochlear implantation as an example from a case series of so far 16 patients.

Despite subtotal cochleoectomy for removal of intracochlear schwannomas cochlear implantation results in good and very good results for hearing rehabilitation.

We advocate surgical removal of intracochlear schwannomas before tumor growth leads to a complete filling of the cochlea, before functional loss increases (e.g. vertigo in addition to hearing loss), or before growth to the IAC and/or the CPA complicates the situation. The surgical technique needs to be tailored to the specific tumor and the individual patient.