• Arianna Di Stadio, Roberta Colangeli, Laura Dipietro, Alessandro Martini, Daniela Parrino, Ennio Nardello, Domenico D'Avella, and Elisabetta Zanoletti.
• San Camillo Hospital IRCCS, Neurology Department, Venice, Italy. Electronic address: ariannadistadio@hotmail.com.
• World Neurosurg. 2018 May 1; 113: 232-237.

BackgroundThe use of surgical cochlear nerve decompression is controversial. This study aimed at investigating the safety and validity of microsurgical decompression via an endoscope-assisted retrosigmoid approach to treat tinnitus in patients with neurovascular compression of the cochlear nerve.Case DescriptionThree patients with disabling tinnitus resulting from a loop in the internal auditory canal were evaluated with magnetic resonance imaging and tests of pure tone auditory, tinnitus, and auditory brain response (ABR) to identify the features of the cochlear nerve involvement. We observed a loop with a caliber greater than 0.8 mm in all patients. Patients were treated via an endoscope-assisted retrosigmoid microsurgical decompression. After surgery, none of the patients reported short-term or long-term complications. After surgery, tinnitus resolved immediately in 2 patients, whereas in the other patient symptoms persisted although they improved; in all patients, hearing was preserved and ABR improved.ConclusionMicrosurgical decompression via endoscope-assisted retrosigmoid approach is a promising, safe, and valid procedure for treating tinnitus caused by cochlear nerve compression. This procedure should be considered in patients with disabling tinnitus who have altered ABR and a loop that has a caliber greater than 0.8 mm and is in contact with the cochlear nerve.Copyright © 2018 Elsevier Inc. All rights reserved.

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