COCHLEAR IMPLANTATION IN A PATIENT AFTER REMOVAL OF AN ACOUSTIC NEUROMA - THE IMPLICATIONS OF MAGNETIC-RESONANCE-IMAGING WITH GADOLINIUM ONPATIENT-MANAGEMENT

The advent of magnetic resonance imaging has allowed otologists to foc us on the early removal of acoustic neuromas with the goal of hearing preservation. Clearly, there are some unpredictable factors, such as p lacement of the tumor in the medial vs the lateral segment of the inte rnal auditory canal and the capricious nature of the blood supply to t hese benign neoplasms, that make prediction of hearing preservation di fficult. Nonetheless, the present goal of surgery for removal of acous tic tumors has changed its focus from preservation of the facial. nerv e alone to preservation of the facial nerve and preservation of hearin g. In a patient with an only-hearing ear and a small acoustic neuroma, there is some controversy concerning whether the tumor should be remo ved early, with the goal of hearing preservation, or if the patient sh ould be allowed to progress to a considerable hearing loss in an effor t to presence natural hearing as long as possible. We report a case in which an acoustic tumor was removed from an only-hearing ear in a pat ient with neurofibromatosis after hearing loss had progressed in that ear but before the development of total deafness. Postoperatively, the patient successfully underwent cochlear implantation. We also discuss decisions that we made during the surgical procedure, as well as the feasibility of cochlear implantation in patients with profound deafnes s after the excision of acoustic neuromas.