Hearing preservation surgery for vestibular schwannoma

Vestibular schwannomas (VS) are rare, benign nerve sheath tumors of the vestibular nerve. VS are frequently associated with sensorineural hearing loss, and management strategies often consider hearing preservation or the risk of iatrogenic hearing loss. While small and asymptomatic VS can be monitored, microsurgical resection is the only treatment option that both removes the tumor and has a possibility of preserving hearing. Commonly utilized hearing preservation approaches include the retrosigmoid (RS) and middle cranial fossa (MCF). The retrolabyrinthine approach has also been described. The RS approach is versatile and can be used for large tumors, but is associated with a higher risk of postoperative headache. The MCF approach has superior hearing preservation rates for smaller tumors, but provides suboptimal access for larger tumors or those with significant extension outside the internal auditory canal (IAC). Overall, hearing preservation is most likely to be achieved for younger patients with excellent baseline hearing and small tumors. Management of VS is ideally performed by an experienced multidisciplinary surgical team at a high-volume center.