Simultaneous Cochlear Implantation and Translabyrinthine Removal of Vestibular Schwannoma in an Only Hearing Ear: Report of Two Cases (Neurofibromatosis Type 2 and Unilateral Vestibular Schwannoma)

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Abstract
The goal is to confirm the effectiveness of cochlear implantation performed at the time of surgery for tumor removal, using a translabyrinthine approach. This is a retrospective case review of two cases of vestibular schwannoma (VS) in the only hearing ear in which a cochlear implant (CI) was placed simultaneous to removal of VS through a modified enlarged translabyrinthine approach. The aim of the study is to confirm the effectiveness in terms of hearing rehabilitation. The study involved a tertiary referral center in a hospital setting. The study includes a report of two cases: a case of a Neurofibromatosis Type 2 (NF2) patient who received a MEDEL COMBI 40+ CI after a translabyrinthine surgery for removal of a large (4.0 cm) cystic VS; and a patient with a 1.2 cm VS in the only hearing ear who was submitted to the same strategy and operation, using a Nucleus 24 Contour CI. The whole strategy used in the two mentioned cases is outlined, including decision making, surgical interventions, and hearing rehabilitation programs. Surgical and audiometric outcome of two patients who underwent VS resection through a translabyrinthine approach and simultaneous cochlear implantation are shown. Postoperative results demonstrate that a CI could be successful after a translabyrinthine surgery for VS, with hearing performances similar to the best postlingual implanted deaf adults of other origin. The present cases demonstrate that cochlear implantation can be successful after a translabyrinthine approach for VS, regardless of the tumor size, the kind of patient (NF2, unilateral VS), and the type of implant. The results also are suggestive that cochlear implantation is more successful if done concurrent with surgery for tumor removal and before hearing is completely lost.