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Hearing Preservation After Microsurgical Resection of Large Vestibular Schwannomas

Di Maio, Salvatore MDCM*; Malebranche, A Daniel MSc†; Westerberg, Brian MD, MHSc*; Akagami, Ryojo MD, MHSc, BSc*

doi: 10.1227/NEU.0b013e31820777b1
Research-Human-Clinical Studies

BACKGROUND: Hearing, which is often still clinically useful at presentation even with larger tumors, is a major determinant of quality of life in vestibular schwannoma (VS) patients.

OBJECTIVE: To present the hearing preservation rate after surgery in patients with large (≥3 cm) VSs and identify clinical or radiologic predictors of hearing preservation.

METHODS: From April 2003 to March 2009, 192 patients underwent resection of a VS, including 46 large (≥3 cm) tumors, of whom 28 had serviceable hearing preoperatively. Six of 28 patients (21.4%) had preserved hearing postoperatively.

RESULTS: Mean tumor diameter was 3.6 cm (range, 3.0-5.0 cm) and tumor volume was 17.2 mL (range, 6.9-45.2 mL). For patients with grade A Sanna-Fukushima hearing, the hearing preservation rate was 4 of 11 (36.4%). Complete resection was achieved in 6 of 6 cases with hearing preservation (41/47 for all patients). Six of 6 patients with preserved hearing had a cerebrospinal fluid cleft in the internal auditory canal (IAC) compared with 9 of 16 patients without preoperative hearing and 9 of 20 for patients with serviceable hearing that was lost postoperatively (P = .045). Six of 6 patients with preserved hearing had less than 35% of the tumor anterior to the longitudinal axis of the IAC compared with 13 of 20 in the serviceable hearing that was lost group (P = .036).

CONCLUSION: Our series demonstrates hearing preservation is possible for patients with large VSs and should be attempted in all patients with preoperative hearing. The quality of preoperative hearing, a cerebrospinal fluid cleft at the apex of the IAC, and a smaller proportion of tumor anterior to the IAC were positively associated with hearing preservation.

*Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; †Division of Otolaryngology, Department of Surgery, St. Paul's Rotary Hearing Clinic, University of British Columbia, Vancouver, British Columbia, Canada

Received, December 23, 2009.

Accepted, June 6, 2010.

Correspondence: Ryojo Akagami, MD, MHSc, BSc, Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, 8109-2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9. E-mail: Ryojo.Akagami@vch.ca

Copyright © by the Congress of Neurological Surgeons