Management of neurovascular compromise of the vestibulocochlear nerve: A systematic review and illustrative case series

To review the outcomes of surgery for asymmetric sensorineural hearing loss (ASHL) from neurovascular compromise of the vestibulocochlear nerve. A systematic review was conducted using the Web of Science, Cochrane, PubMed, and PsychINFO databases. We additionally performed a retrospective review of our institution’s database for cases with ASHL resulting from vascular loop-induced vestibulocochlear nerve compression. Fifteen articles were included in our literature review, representing a total of 24 patients. Of these 24 patients, 8 patients were managed conservatively, and 16 patients were managed surgically. Among the patients who underwent conservative management, 4 patients (50%) had no reported vestibulocochlear post-treatment outcomes. One patient mentioned subjectively improved hearing, whereas the remaining patients either had no change or worsening of hearing loss. One patient reported tinnitus improvement, while another had persistent tinnitus and vertigo. Among the 16 patients who underwent surgery, 7 patients (44%) showed improved hearing postoperatively, while 1 patient’s hearing continued to deteriorate. Improvement of vertigo/disequilibrium and tinnitus was mentioned in 11 and 9 patients, respectively. Separately, our institution presented 2 patients: one treated surgically with mild hearing improvement and another managed conservatively with ongoing evaluation. Indications for treatment of ASHL with associated vascular loop causing vestibulocochlear nerve compression remain unclear. Overlapping vestibulocochlear symptoms of hearing loss and pulsatile tinnitus within a patient case seem of higher surgical priority versus a patient case with worsening hearing.