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NF2: State of The Art – Morning of Day 2

The majority of this morning’s presentations focused on auditory rehabilitation using devices including the auditory brainstem implant (ABI), the more recently developed penetrating ABI, and the cochlear implant. The ABI was pioneered at the House Ear Institute, and Dr. William Hitselberger from that institution was honored with a Lifetime Achievement Award Monday evening to recognize a career that included his pioneering role in ABI development.   Use of ABI has now expanded around the world; overall, ABI implantation is deemed a safe procedure, though interestingly different clinics report not only different approaches to implantation but also different success rates in restoration of hearing function. Particular success in hearing restoration in adults has been accomplished by Dr. Vittorio Colletti in Europe, while Dr. Liliana Colletti reported successful implantation of ABIs into young children in Italy.  Dr. Pamela Roehm from NYU Langone reviewed data from the literature and from her own center regards experience with cochlear implants in NF2 patients. Observations included: implantation of cochlear implant at time of tumor removal appears to be a successful approach, though implanting a cochlear implant when hearing is still functional in contralateral ear may not yield the best long term results.  Group discussions raised the possible value of developing a combined cochlear implant – auditory brainstem implant device.

The morning was rounded out by a controversial topic, use of radiosurgery for the treatment of schwannoma. Dr. John Adler (Stanford University) reported from the perspective that radiosurgery can be useful in treatment of NF2 schwannomas though not always with results as successful as sporadic schwannomas. He proposed that what is needed is an NF2 database to include outcomes of borth microsurgery and radiotherapy to provide a fair comparison.  Simon Lloyd, a late addition to the agenda, shared analysis of a small database of this nature from Manchester, which in a preliminary analysis suggested radiosurgery is overall less effective in controlling tumor growth and does carry risks including potential increased hearing loss and tumor regrowth.