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Prognostic Factors of Long-Term Hearing Preservation in Small and Medium-Sized Vestibular Schwannomas After Microsurgery

Huo, Zirong*,†,‡; Chen, Jianqing*,†,‡; Wang, Zhaoyan*,†,‡; Zhang, Zhihua*,†,‡; Wu, Hao*,†,‡

doi: 10.1097/MAO.0000000000002284
TUMORS OF THE EAR AND CRANIAL BASE
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Objective: The authors evaluated the long-term hearing outcomes of patients with vestibular schwannoma (VS) to explore appropriate surgical treatment.

Study Design: Retrospective study.

Setting: Tertiary referral center.

Patients: A total of 138 patients diagnosed with small and medium-sized VS with serviceable hearing from January 2006 to December 2015.

Interventions: All patients underwent microsurgery via retrosigmoid (RSA) or middle cranial fossa approach (MFA) and were followed up for over 2 years.

Main Outcome Measures: Pre- and postoperative hearing, including pure tone audiometry, speech discrimination score, and auditory brainstem response (ABR), were analyzed.

Results: The mean tumor size and volume were 16.6 ± 3.4 mm and 1711.8 ± 918.5 mm3, respectively. Preoperative hearing levels were Class A in 42, Class B in 67, and Class C in 29 patients. Patients with a tumor from the superior vestibular nerve (SVN) had better hearing at diagnosis. Postoperative hearing levels were Class A, B, C, and D for 28, 17, 32, and 61 patients. Hearing outcomes were significantly better in patients with normal intraoperative I wave on ABR. Hearing loss within 6 months had a positive effect on postoperative hearing. Better preoperative hearing and tumors from SVN were correlated with better postoperative hearing outcomes. Tumor size, cystic variation, or extension to the fundus of internal auditory canal had no influence on hearing preservation.

Conclusions: Better preoperative hearing, shorter hearing loss period, tumors from SVN, and normal intraoperative I wave are prognostic factors for serviceable hearing. RSA and MFA are effective and safe for tumor removal and hearing preservation.

*Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital

Ear Institute, Shanghai Jiaotong University School of Medicine

Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China

Address correspondence and reprint requests to Zhihua Zhang, M.D., Ph.D., Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Zhizaoju Road #639, Shanghai 200011, China; E-mail: zhihuazhang0504@126.com; Hao Wu, M.D., Ph.D., Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Zhizaoju Road #639, Shanghai 200011, China; E-mail: wuhao622@sina.cn

The authors declare that the manuscript has not been published previously or is under consideration for publication elsewhere. Its publication is approved by all authors, and if accepted, it will not be published elsewhere in similar form, in any language, without the consent of Lippincott Williams & Wilkins. Each person listed as an author has participated in the study to a significant extent.

Funding: This work was supported by grants from the National Natural Science Foundation of China [grant number 81470681, 81570906, and 81870712].

The authors declare that they have no conflicts of interest.

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