Vertigo and Tinnitus Caused by Vascular Compression of the Vestibulocochlear Nerve, Not Intracanalicular Vestibular Schwannoma: Review and Case Presentation

ABSTRACT

Microvascular compression of the vestibulocochlear nerve is known to cause disabling tinnitus and vertigo. A review of the literature shows that the compression is usually located in the cerebellopontine angle, and that it is usually caused by an artery. The authors add the case of a 46-year-old man with venous compression of the vestibulocochlear nerve inside the internal auditory canal (IAC). The patient presented with a 2-year history of recurrent attacks of disabling vertigo and intermittent high-frequency tinnitus on the right side. Magnetic resonance images showed a small, contrast-enhancing lesion in the fundus of the right IAC, which was suspicious for vestibular schwannoma. During surgical exploration, a large venous loop was found extending into the IAC and compressing the vestibulocochlear nerve. The vessel was mobilized and rerouted out of the IAC. The presumed vestibular schwannoma at the cochlear fossa was left in situ. The patient's symptoms resolved immediately after surgery. Hearing was unchanged postoperatively. On follow-up, there has been no growth of the contrast-enhancing lesion in the IAC for 3 years so far.

Disabling vertigo can also be caused by venous microvascular compression of the vestibulocochlear nerve inside the IAC and may be treated successfully by microvascular decompression. A sensitive, conservative approach to lesions in the fundus may be justified in the presence of an additional, more prominent pathology that causes compression of the vestibulocochlear nerve.

KEYWORDS

Acoustic neuroma - microvascular decompression - tinnitus - vertigo - vestibulocochlear nerve - vestibular schwannoma

REFERENCES

• 1 Kim H N, Kim Y, Park I, Kim G, Chung I. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle.  Ann Otol Rhinol Laryngol. 1990;  99 288-296
• 2 Martin R G, Grant J L, Peace D, Theiss C, Rhoton A L. Microsurgical relationships of the anterior inferior cerebellar artery and the facial-vestibulocochlear nerve complex.  Neurosurgery. 1980;  6(5) 483-507
• 3 Padget D. The development of the cranial arteries in the human embryo.  Contrib Embryol. 1948;  32 207-261
• 4 Rhoton Jr A L. Microsurgical anatomy of the posterior fossa cranial nerves.  Clin Neurosurg. 1979;  26 398-462
• 5 Jannetta P J. Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients.  Neurochirurgia (Stuttg). 1977;  20 145-154
• 6 Bertrand R A, Molina P, Hardy J. Vestibular syndrome and vascular anomaly in the cerebello-pontine angle.  Acta Otolaryngol. 1977;  83 187-194
• 7 De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L. Is the root entry/exit zone important in microvascular compression syndromes?.  Neurosurgery. 2002;  51(2) 427-433
• 8 De Ridder D, Ryu H, Møller A R, Nowé V, Van de Heyning P, Verlooy J. Functional anatomy of the human cochlear nerve and its role in microvascular decompressions for tinnitus.  Neurosurgery. 2004;  54 381-388
• 9 Ryu H, Yamamoto S, Sugiyama K, Nishizawa S, Nozue M. Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptoms?.  Acta Neurochir (Wien). 1999;  141(5) 495-501
• 10 Schwaber M K, Hall J W. Cochleovestibular nerve compression syndrome. I. Clinical features and audiovestibular findings.  Laryngoscope. 1992;  102 1020-1029
• 11 Møller M B, Møller A R, Jannetta P J, Jho H D, Sekhar L N. Microvascular decompression of the eighth cranial nerve in patients with disabling positional vertigo: selection criteria and operative results in 207 patients.  Acta Neurochir (Wien). 1993;  125 75-82
• 12 Brackmann D E, Kesser B W, Day J D. Microvascular decompression of the vestibulocochlear nerve for disabling positional vertigo: the House Ear Clinic experience.  Otol Neurotol. 2001;  22 882-887
• 13 Okamura T, Kurokawa Y, Ikeda N et al.. Microvascular decompression for cochlear symptoms.  J Neurosurg. 2000;  93 421-426
• 14 De Ridder D, De Ridder L, Nowé V, Thierens H, Van de Heyning P, Møller A. Pulsatile tinnitus and the intrameatal vascular loop: why do we not hear our carotids?.  Neurosurgery. 2005;  57(6) 1213-1217
• 15 Michel O, Jahns T, Joost-Enneking M, Neugebauer P, Streppel M, Stennert E. The Stennert antiphlogistic-rheologic infusion schema in treatment of cochleovestibular disorders.  HNO. 2000;  48(3) 182-188
• 16 Samii M, Matthies C, Tatagiba M. Intracanalicular acoustic neurinomas.  Neurosurgery. 1991;  29(2) 189-198
• 17 Matthies C, Samii M. Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation.  Neurosurgery. 1997;  40(1) 1-9
• 18 Bachor E, Selig Y, Jahnke K, Rettinger G, Karmody C. Vascular variations of the inner ear.  Acta Otolaryngol. 2001;  121(1) 35-41
• 19 Møller M B. Results of microvascular decompression of the eighth nerve as treatment for disabling positional vertigo.  Ann Otol Rhinol Laryngol. 1990;  99(9 Pt 1) 724-729
• 20 Møller M B, Møller A R, Jannetta P J, Jho H D. Vascular decompression surgery for severe tinnitus: selection criteria and results.  Laryngoscope. 1993;  103 421-427
• 21 Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients.  Acta Neurochir (Wien). 2002;  144(1) 1-12 discussion 12-13
• 22 Matsushima T, Huynh-Le P, Miyazono M. Trigeminal neuralgia caused by venous compression.  Neurosurgery. 2004;  55(2) 334-337 discussion 338-339
• 23 Rhoton Jr A L, Tedeschi H. Microsurgical anatomy of acoustic neuroma.  Neurosurg Clin N Am. 2008;  19 145-174
• 24 Lapsiwala S B, Pyle G M, Kaemmerle A W, Sasse F J, Badie B. Correlation between auditory function and internal auditory canal pressure in patients with vestibular schwannomas.  J Neurosurg. 2002;  96(5) 872-876
• 25 Casselman J W, Kuhweide R, Deimling M, Ampe W, Dehaene I, Meeus L. Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle.  AJNR Am J Neuroradiol. 1993;  14 47-57
• 26 Dubrulle F, Ernst O, Vincent C, Vaneecloo F M, Lejeune J P, Lemaitre L. Cochlear fossa enhancement at MR evaluation of vestibular schwannoma: correlation with success at hearing-preservation surgery.  Radiology. 2000;  215 458-462
• 27 Kocaoglu M, Bulakbasi N, Ucoz T et al.. Comparison of contrast-enhanced T1-weighted and 3D constructive interference in steady state images for predicting outcome after hearing-preservation surgery for vestibular schwannoma.  Neuroradiology. 2003;  45 476-481
• 28 Brookes G B, Woo J. Hearing preservation in acoustic neuroma surgery.  Clin Otolaryngol Allied Sci. 1994;  19(3) 204-214
• 29 Gharabaghi A, Samii A, Koerbel A, Rosahl S K, Tatagiba M, Samii M. Preservation of function in vestibular schwannoma surgery.  Neurosurgery. 2007;  60(2, Suppl 1) ONS124-ONS127
• 30 Haines S J, Levine S C. Intracanalicular acoustic neuroma: early surgery for preservation of hearing.  J Neurosurg. 1993;  79(4) 515-520
• 31 Møller P, Myrseth E, Pedersen P, Larsen J L, Krakenes J, Moen G. Acoustic neuroma—treatment modalities. Surgery, gamma-knife or observation?.  Acta Otolaryngol Suppl. 2000;  543 34-37
• 32 Thomsen J, Charabi S, Tos M, Mantoni M, Charabi B. Intracanalicular vestibular schwannoma - therapeutic options.  Acta Otolaryngol Suppl. 2000;  543 38-40
• 33 Selesnick S H, Rebol J, Heier L A, Wise J B, Gutin P H, Lavyne M H. Internal auditory canal involvement of acoustic neuromas: surgical correlates to magnetic resonance imaging findings.  Otol Neurotol. 2001;  22 912-916
• 34 Somers T, Casselman J, de Ceulaer G, Govaerts P, Offeciers E. Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma.  Otol Neurotol. 2001;  22 87-94