Analysis of Hearing Preservation in Middle Cranial Fossa Resection of Vestibular Schwannoma

Abstract

Objective:Describe the effect of preoperative hearing on the likelihood of hearing preservation after middle cranial fossa (MCF) approach for resection of vestibular schwannoma (VS) and the effect of hearing preservation on disease-specific quality of life (QOL).Study design:Retrospective chart review.Setting:Academic tertiary care skull base surgery program.Patients:Sixty three adult patients with preoperative word recognition score (WRS) ≥50% who underwent MCF resection of VS between 2017 and 2020.Interventions:All patients underwent MCF VS resection with attempted hearing preservation.Main outcome measures:Hearing preservation (postoperative WRS ≥50%), hearing-related Penn Acoustic Neuroma Quality of Life (PANQOL) score.Results:Sixty three patients with mean age 47.4 (±9.6) years and tumor size 11.5 (±0.5) mm were analyzed. Hearing was preserved (+HP) and lost (−HP) in 37 (58.7%) and 26 (41.3%) patients, respectively. Preoperatively, pure tone average audiometry was significantly lower among the +HP group (20.0 dB) versus −HP (31.0 dB, p < 0.003). WRS was higher among +HP versus −HP (94% vs. 84%, respectively; p < 0.002). Linear regression showed that intra- versus extra-canalicular tumor location, sudden hearing loss history, fundal fluid cap thickness, and tumor size had no relationship to hearing preservation outcomes. When evaluating postoperative QOL data (n = 37) hearing-related PANQOL score differed between +HP and −HP (t35 = 2.458, p = 0.0191) groups.Conclusions:In this cohort of patients undergoing MCF resection of VS, rates of HP were higher for patients with excellent preoperative hearing. Postoperatively, +HP patients reported improved hearing-related PANQOL scores compared to −HP patients.

Brazilian Society of Otology task force – Vestibular Schwannoma ‒ evaluation and treatment

“…The MF approach is chosen based on the surgeon’s preference, tumor size, and degree of lateral IAC involvement. 162 , 179 , 180 , 181 , 182 , 183 …”

Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma

“…There is a tough balance between the timing of the surgical intervention and follow-up with possible hearing loss. Most previous studies have discussed the predictors of postoperative HP in VS patients (6,7,12–15), but they seldom involve comprehensive analysis and model prediction of those factors. Based on the analysis of predictors, we established a nomogram model for predicting postoperative HP in VS patients and verified the stability and accuracy of the model with an independent internal dataset, which is convenient to apply in clinical practice.…”

Hearing Outcomes from Gamma Knife Treatment for Intracanalicular Vestibular Schwannomas with Good Initial Hearing

“…The durability of hearing preservation should be reported as well because continued reduction over time in serviceable hearing after GKS is often reported [ 1 , 4 , 27 ], with an acceleration of the decrease between years 5 and 10 [ 8 ], whereas hearing preservation after microsurgery is thought to be more durable [ 5 ]. Moving from class A to class B is still beneficial for the patients because the patients with post-GKS serviceable hearing may benefit from a unilateral hearing aid on the tumor side, whereas CROS or BICROS are more indicated for patients with post-GKS classes C and D.…”