Bilateral reversible deafness after surgery for unilateral epidermoid tumor: an unusual complication : Case report

• Published in: Neurosurgery Vol. 56; no. 4; pp. E870; discussion E870 - E870
• Main Authors: COLPAN, Mustafa Efkan, SEKERCI, Zeki, BERK, Caglar
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-04-2005
• Subjects: Adult; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - surgery; Craniotomy - adverse effects; Deafness - etiology; Functional Laterality; Hearing Loss, Sensorineural - etiology; Humans; Male; Medical sciences; Neurosurgery; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Case study; Deafness; Nervous system diseases; Surgery; Auditory disorder; Reversible hearing loss; ENT disease; Complication; Tumor; Pontocerebellar junction; Epidermoid tumor; Hearing loss
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/01.NEU.0000156490.47554.EE

We present an unusual complication of bilateral hearing loss after surgery for unilateral epidermoid tumor situated at the right pontocerebellar junction. The neurosurgeon must know the possible causes of this catastrophic complication and should take every possible measure to avoid it.
A 43-year-old male patient presented with progressive hearing loss in the right ear. A radiological examination demonstrated a mass lesion at the right pontocerebellar junction. A pure tone audiogram revealed sensorineural hearing impairment of the right ear. A brainstem auditory evoked potential test confirmed this with reduced amplitudes and a prolonged I-V interval.
The patient was operated on via a right paramedian suboccipital craniectomy. The tumor was completely excised, and all of the cranial nerves were preserved during the operation. Postoperatively, the patient developed total bilateral hearing loss, which improved significantly over time.
Controlled cerebrospinal fluid drainage during exposure and tumor excision may reduce the possibility of shift and traction on the neural structures and help to prevent ischemic injury. Frequent irrigation of the surgical field and minimizing the spilling of the tumor contents may reduce the risk of chemical irritation. The use of corticosteroids may also help during the postoperative period.