Preoperative Audiometry May Predict Hearing Improvement After Cerebellopontine Angle Meningioma Resection

Identify common characteristics in patients who had hearing improvement after cerebellopontine angle (CPA) meningioma resection.

Adult patients who underwent hearing-preservation-intent CPA meningioma resection.

Data collected included patient, tumor, and surgical factors. Surgical approaches were retrosigmoid, combined petrosal, or anterior petrosectomy.

Preoperative and postoperative word recognition scores (WRS), pure-tone average (PTA), and AAO-HNS hearing classification.

Fifteen female patients (mean age: 52.5±14.4 y) underwent resection of CPA meningiomas (mean CPA dimension: 3.2±1.6 cm). Facial nerve function (House-Brackmann grade I or II) was preserved in all cases. Six of 10 (60%) of patients with serviceable preop hearing had hearing preserved, and 3 patients (20%) demonstrated improvement in AAO-HNS hearing class. These patients had preoperative WRS ranging from 0% to 32% and PTA from 32.5 to 42.5 dB. Tumors were inframeatal, retromeatal, or intracanalicular, with gross total resection in 2 cases. Median AAO-HNS hearing class improved from D to B, and mean WRS increased from 21.3% to 80.3% (P=0.01). Patients with hearing improvement had a worse mean preoperative WRS than patients without improvement (21.3% vs. 80%, P<0.01). No other single variable-including tumor CPA and IAC dimensions, location, surgical approach, extent of resection, age, or PTA-was predictive of hearing improvement.

Hearing improvement was observed in a subset of CPA meningioma patients, particularly those with disproportionately poor WRS relative to PTA. These patients may benefit from a hearing-preservation surgical strategy.