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Vascularization between vestibular schwannomas and the adjacent eighth cranial nerve was examined in order to elucidate the angiogenic effect of these tumours. Specimens from 12 patients were examined by light microscopy and immunohistochemistry (series 1), while specimens from another 17 patients were examined by light and transmission electron microscopy (series 2). Slight to marked angiogenesis was found in 5 patients from series 1 and 7 patients from series 2. Ultrastructural examination indicated that these blood vessels were more fragile than those in the normal eighth cranial nerve. These findings suggested that sudden hearing loss in vestibular schwannoma patients may be related to the disruption of such blood vessels. In addition, surgical injury to these blood vessels may cause postoperative hearing loss despite preservation of the cochlear nerve.

The central-peripheral transitional region (TR) of the eighth nerve root was obtained from 8 patients with cerebellopontine angle schwannoma and investigated by light microscopy, electron microscopy, and immunohistochemistry. As a control, the TRs of 6 autopsy patients without any otologic disease were studied. Astrocytic proliferation at the TR was more prominent in the schwannoma patients than in the normal controls. Mild gliosis of the mantle zone of the TR was found in 5 schwannoma patients and moderate gliosis was noted in 3. The distribution of capillaries at the TR differed between the schwannoma patients and the normal controls. In the schwannoma patients, capillaries were rarely found in the mantle zone of the TR but were densely clustered at the glial fringe zone, especially near its border with the peripheral nervous tissue. Stasis of the capillaries in the glial fringe zone was frequently noted. These histological findings may indicate the occurrence of gliosis in response to eighth nerve degeneration. We suggest that there is increased susceptibility of the eighth nerve to injury at the TR in patients with schwannoma.

Vascular casting has so far been used mainly for observation of the vascular system of the inner ear in experimental animals. In the present study, this method was applied to analysis of the three-dimensional vascular structure in the inner ear in humans. To date there has been no comparative study of overall pictures of blood vessels in the human inner ear. Seven cases were observed mainly by means of scanning electron microscopy. Even with this new method, the results in many respects obtained confirmed those of previous reports. However, the following findings which have not been previously reported or are currently in dispute, were observed: i) In two cases, spring coil-like structures of blood vessels were found in the internal auditory canal; ii) We corroborated the pattern of arrangement of cochlear arteries previously described in words and schemata, i.e., the following two types were confirmed: the first type showing the cochlear branch of vestibulocochlear artery and the spiral modiolar artery running into the cochlea, and the second type showing the cochlea supported by arteries derived from the artery corresponding to the vestibulocochlear artery, alone; and iii) A right-angled arteriolar branch of the spiral modiolar artery was found to further bifurcate to form radiating arterioles extending in two directions: both over the scala vestibuli and along the spiral lamina.

The transitional region of the eighth cranial nerve, where the central and peripheral nervous tissues are contiguous, was studied by electron microscopy using surgically resected specimens of the human eighth cranial nerve root. The astrocytic glial dome was sharply demarcated by a basement membrane from the peripheral portion of the nerve. Half-desmosomes were found on the edge of the astrocytic glial dome and at the luminal surface of the perivascular glial limiting membrane. Desmosomes and gap junctions were found between the astrocytic processes. These ultrastructural features suggest a weak link between the central and peripheral portions of the nerve which might predispose the transitional region to injury, although the peripheral and central portions have sufficient resistance to external stresses independently.