Hearing preservation in conservation surgery for vestibular schwannoma

Objective: To evaluate preservation of hearing in the resection of vestibular schwannomas. Study Design: A retrospective case review. Setting: Tertiary-care medical center. Patients: Forty-seven patients (25 men, 22 women) were studied; mean age was 46 years, mean tumor diameter 9.8 mm (range 3-30 mm.) Interventions: All patients underwent resection of vestibular schwannomas by the middle cranial fossa (MCF) or the retrosigmoid (RS) approach. Main Outcome Measures: Hearing preservation was classified by the criteria outlined by the American Academy of Otolaryngology-Head Neck Surgery. Hearing was assessed preoperatively and postoperatively at 1 month and 1 year. Facial function was graded according to the House-Brackmann scale. Minimum follow-up was 18 months. Results: Hearing was preserved in 69% of patients who underwent the MCF approach but in only 33% of patients for whom the RS approach was used. The RS approach was used for larger tumors (mean diameter 15 mm) and the MCF procedure for smaller tumors (mean diameter 9 mm). One hundred percent of patients had facial function H/B grade II or better, regardless of approach. Conclusion: Hearing function can be reliably preserved in a high percentage of selected patients undergoing resection of vestibular schwannoma.