Hearing Preservation after Middle Fossa Vestibular Schwannoma Removal: Are the Results Durable?

Abstract

Objectives: (1) Describe hearing preservation rates following microsurgical excision of vestibular schwannoma (VS) via middle cranial fossa (MCF) approach. (2) Evaluate long- term hearing outcomes after hearing preservation. Methods: This is a retrospective case series of patients with VS who underwent resection via a MCF approach between February 1998 and December 2009 at a tertiary care academic medical center. Audiograms including pure tone average (PTA) and word recognition score (WRS) were obtained preoperatively, immediately postoperatively, and at 5-year follow-up. Results: Sixty patients underwent MCF during the study period. Preoperative serviceable hearing (American Academy of Otolaryngology—Head and Neck Surgery class A/B) was present in 52 (86%) of the 60 subjects, with an average PTA of 22 dB (range, 1-50 dB) and an average WRS of 97% (range, 76-100%). Immediate postoperative serviceable hearing was maintained in 29 (55%) of the subjects, with an average PTA and WRS of 31 dB (5-50 dB) and 96% (70-100%), respectively. Five-year follow-up was obtained for 18 of the 29 subjects. After 5-year follow-up, 14 (78%) of the 18 subjects maintained serviceable hearing with an average PTA and WRS of 33 dB (4-49 dB) and 95% (84-100%), respectively. Of the 4 patients who did not maintain class A/B hearing, average change in PTA and WRS was 17 dB (5.5-23 dB) and 16% (0%-40%), respectively. The patient with the most dramatic change in 5-year hearing had a tumor recurrence. Conclusions: For patients with VS in whom serviceable hearing is preserved following MCF approach, the long term hearing outcome remains durable in the majority of patients.