Plans Gerard, Torres Alberto, Ferran Enrique, Aparicio Alberto, Acebes Juan J
Department of Neurosurgery, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
Neurosurgery. 2007 Oct;61(4):E878; discussion E878. doi: 10.1227/01.NEU.0000298920.39872.62.
To describe a case of contralateral hearing loss (CHL) in vestibular schwannoma (VS) surgery and to discuss the factors potentially related with this complication.
A 48-year-old man awakened with complete bilateral hearing loss after an uneventful retrosigmoid excision of a 20 mm left-sided VS. The patient had no complaints of vertigo or facial palsy on the contralateral side. The hearing loss proved to be endocochlear in origin and no improvement was observed after a 24-month follow-up period.
CHL in VS surgery is not commonly reported but can occur frequently as a subclinical phenomenon if it is specially addressed. The cause is a compensatory endolymphatic hydrops generated by the loss of cerebrospinal fluid. In this circumstance, the hearing loss is usually reversible within 3 months, but irreversible cases have been described. Vascular damage to the cochlea can be another explanation in irreversible cases. The significance of other potential factors described in the literature as a cause of CHL in VS surgery is less clear.
A case of CHL after VS surgery is presented. The hearing loss proved to be endochlear in origin and irreversible in nature. Irreversible damage to the cochlea resulting from loss of cerebrospinal fluid or vascular injury is probably related in this case reported.
描述1例前庭神经鞘瘤（VS）手术中出现对侧听力丧失（CHL）的病例，并探讨可能与该并发症相关的因素。
一名48岁男性在顺利切除左侧20 mm VS后，行乙状窦后入路手术，术后醒来出现双侧完全性听力丧失。患者对侧无眩晕或面瘫主诉。听力丧失被证明起源于蜗内，24个月的随访期后未观察到改善。
VS手术中的CHL并不常见报道，但如果特别关注，可能经常作为一种亚临床现象出现。其原因是脑脊液流失导致的代偿性内淋巴积水。在这种情况下，听力丧失通常在3个月内可逆，但也有不可逆病例的描述。耳蜗血管损伤可能是不可逆病例的另一种解释。文献中描述的其他可能导致VS手术中CHL的因素的意义尚不清楚。
本文报道1例VS手术后发生CHL的病例。听力丧失被证明起源于蜗内且本质上不可逆。在本报道的病例中，脑脊液流失或血管损伤导致的耳蜗不可逆损伤可能与之相关。
