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Decompression internal auditory canal11/28/2023 To date, only 26 cases of exostoses and/or osteomas resulting in stenosis of the IAC have been reported.Ĭlinical outcomes following surgery are variable, and the likelihood of neurological stability or recovery have not been previously explored in this population. Once radiographic evidence confirms a symptomatic lesion, surgical decompression of neurovascular structures is considered to prevent further progression of symptoms. Radiographic imaging is not consistently reliable in differentiating these two lesions, and frequently histopathology is necessary for the final diagnosis. These patients often present with sensorineural hearing loss, vertigo, and/or tinnitus, caused by compression of neurovascular structures within the cerebellopontine angle. Internal acoustic canal (IAC) osteomas and exostoses are exceedingly rare, with only a small number of reports existing in the literature.Īlthough histologically distinct, both lesions can present with hyperostotic growth adjacent to the IAC resulting in compression of neurovascular structures. Although the role of surgical decompression remains unclear, it appears that patients presenting with vertigo have more favorable response to surgical decompression as compared with those presenting with tinnitus and sensorineural hearing loss.Įxostoses and osteomas are benign lesions originating from the calvarium and facial bones. IAC exostoses and osteomas are rare lesions that lead to insidious onset of debilitating symptoms from vestibulocochlear nerve dysfunction. Of the 13 patients who underwent surgical decompression, 8 patients had resolution of vertigo symptoms, 10 patients had improvement of tinnitus symptoms, and all patients maintained some level of serviceable hearing. A total of 26 reported cases were identified, and patient presenting symptoms, management strategies, and response to surgery was obtained when available. We present two cases of IAC exostoses managed with surgical decompression and review the clinical outcomes of previously reported cases in the literature.Ī comprehensive search was conducted using PubMed Central, Web of Science Core Collection, and Google Scholar databases to identify previous reports of IAC exostoses and osteomas. All rights reserved.Exostoses and osteomas are benign, insidious lesions of the bone involving the internal acoustic canal (IAC). Hearing loss Loop Neurovascular conflict Retrosigmoid approach Surgical decompression Tinnitus.Ĭopyright © 2018 Elsevier Inc. This procedure should be considered in patients with disabling tinnitus who have altered ABR and a loop that has a caliber greater than 0.8 mm and is in contact with the cochlear nerve. Microsurgical decompression via endoscope-assisted retrosigmoid approach is a promising, safe, and valid procedure for treating tinnitus caused by cochlear nerve compression. After surgery, tinnitus resolved immediately in 2 patients, whereas in the other patient symptoms persisted although they improved in all patients, hearing was preserved and ABR improved. After surgery, none of the patients reported short-term or long-term complications. Patients were treated via an endoscope-assisted retrosigmoid microsurgical decompression. We observed a loop with a caliber greater than 0.8 mm in all patients. Three patients with disabling tinnitus resulting from a loop in the internal auditory canal were evaluated with magnetic resonance imaging and tests of pure tone auditory, tinnitus, and auditory brain response (ABR) to identify the features of the cochlear nerve involvement. This study aimed at investigating the safety and validity of microsurgical decompression via an endoscope-assisted retrosigmoid approach to treat tinnitus in patients with neurovascular compression of the cochlear nerve. The use of surgical cochlear nerve decompression is controversial.
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