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Hearing Preservation and Vestibular Schwannoma: Intracochlear FLAIR Signal Relates to Hearing Level

Miller, Mia E.*; Mafee, Mahmood F.; Bykowski, Julie; Alexander, Thomas H.; Burchette, Raoul J.; Mastrodimos, Bill§; Cueva, Roberto A.§

doi: 10.1097/MAO.0000000000000191
Tumors of the Ear & Cranial Base

Objectives This study aimed to evaluate the relationship between cochlear signal on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences and hearing in patients undergoing hearing preservation surgery for vestibular schwannoma (VS) and to demonstrate a new classification system to be used in imaging evaluation of patients with VS.

Methods A search of archived surgical cases at a single institution between January 1, 2006, and January 1, 2012, revealed 51 patients who underwent hearing preservation surgery for VS. Tumor size, patient age and sex, and preoperative and postoperative pure-tone average (PTA) and speech discrimination score (SDS) were recorded. Cochleae on the affected side were examined on preoperative FLAIR sequences and classified as limited hyperintensity (LH) or extensive hyperintensity (EH).

Results Mean patient age was 51 years, and mean tumor size was 1.3 cm. Preoperative FLAIR sequences were classified into LH (n = 36) and EH (n = 15) categories. Preoperative PTA and SDS were 29.5 dB (SD, 16.7), 90% (SD, 14) and 40.6 dB (SD, 13.8), 80% (SD, 25) for LH and EH, respectively. On univariate analysis, preoperative PTA was superior in the LH group (p = 0.04). There was a trend toward superior preoperative SDS and postoperative PTA in the LH group, but these differences were not statistically significant (p = 0.08 and p = 0.06, respectively).

Conclusion The current study is the first to demonstrate a distinct association between cochlear FLAIR signal and pretreatment hearing levels in patients with VS. A new classification system for evaluating cochlear FLAIR signal is proposed. Improvement in FLAIR sequences will allow further investigation of this association.

*University of California at San Francisco Medical Center, San Francisco, CA, U.S.A.; †University of California at San Diego Medical Center, San Diego, CA, U.S.A.; ‡Kaiser Permanente, Los Angeles, CA, U.S.A.; and §Kaiser Permanente San Diego, CA, U.S.A.

Address correspondence and reprint requests to Mia E. Miller, M.D., care of Roberto Cueva, M.D., 5893 Copley Dr., San Diego, CA 92111, U.S.A.; E-mail:

The author disclose no conflicts of interest.

This article is associated with a presentation at the American Neurotology Society Meeting at Combined Otolaryngological Spring Meetings, April 12–14, 2013.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company