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Hearing preservation with the middle cranial fossa approach for neurofibromatosis type 2
Rick A Friedman1, John C Goddard, Eric P Wilkinson
1House Clinic and House Research Institute, Los Angeles, California, USA. RFriedman@hei.org
Objectives:
To examine hearing preservation rates, facial nerve outcomes, and tumor recurrence rates in patients with neurofibromatosis Type 2 undergoing a primary middle cranial fossa approach for vestibular schwannoma removal.
Study Design:
Retrospective chart review.
Setting:
Private practice tertiary neurotology referral center.
Patients:
All patients with neurofibromatosis Type 2 undergoing attempted hearing preservation via a middle cranial fossa approach for removal of vestibular schwannoma from January 1, 2000, to June 1, 2010.
Intervention:
Primary middle cranial fossa approach for removal of vestibular schwannoma.
Main Outcome Measures:
Preoperative, postoperative, and change in hearing thresholds, word recognition scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class, House-Brackmann facial nerve grade, and tumor recurrence.
Results:
Class A or B hearing according to the American Academy of Otolaryngology-Head and Neck Surgery was maintained in 50% of cases, whereas 63.6% had Class A, B, or C hearing, with an average word recognition score of 93.8% at an average follow-up period of 32.5 months. Facial nerve outcomes were excellent; 75% of cases maintained House-Brackmann Grade 1, whereas 94.3% had Grade 1 or 2 at an average of 25 months after surgery. Tumor growth within the surgical field was observed radiographically in 59% of cases.
Conclusion:
In patients with neurofibromatosis Type 2, proactive treatment of smaller tumors provides a chance to maintain serviceable hearing and obtain tumor control for extended periods. When examining hearing outcomes, it is important to use word recognition scores, in addition to American Academy of Otolaryngology-Head and Neck Surgery hearing class, to better assess functionality. Although facial nerve outcomes tend to be favorable, the growth of new tumors, including facial schwannomas, may occur within the surgical field. Continued surveillance with serial magnetic resonance scans after surgery is mandatory.