Abstract
Hearing preservation microsurgery for vestibular schwannomas (VSs) offers favorable hearing preservation rates for small tumors in patients with serviceable hearing. The natural history of VSs is slow growth of 1–2 mm per year; however, some tumors do not grow. Hearing loss can occur gradually or suddenly independent of tumor growth. Management options include observation, microsurgical removal, and radiosurgery. Hearing preservation rates are approximately 72 % with middle cranial fossa microsurgery for small tumors ( 70 % word discrimination). Hearing preservation is approximately 50 % with larger tumors not yet touching the brainstem. Longitudinal studies show a 5-year hearing preservation rate for observation of around 50 %. Radiosurgery should not be used as a hearing preservation modality as the 10-year serviceable hearing rates are only around 25 %. Also, observation and radiosurgery do not eradicate the tumor. Normal or near-normal facial nerve function rates are in the 90 % range for all three options. Thus, we favor microsurgical removal for small tumors in young healthy patients.
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