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Hearing preservation in vestibular schwannoma surgery: what factors influence outcome?
K D Post1, M B Eisenberg, P J Catalano
1Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
Abstract:
The goals in the management of patients with vestibular schwannomas have changed drastically over the past few decades, with preservation of useful hearing representing the newest challenge. The true incidence of preserved useful hearing, however, has become clouded by a lack of uniformity in reporting results. The authors have analyzed 56 consecutive cases, in which directed attempts were made to preserve hearing on the involved side, to understand what factors play a major role in postoperative hearing preservation. Of the 56 cases reviewed, there were 46 patients who had "good" preoperative hearing (pure tone average < 50 dB; speech discrimination score > 50%). We found that, in this group of patients, if the tumor was less than 2 cm in diameter from pons to petrous, there was a 52% (16 of 31 patients) chance of preserving good hearing and if the tumor was 1 cm or less, the chances increased to 83%. Factors such as preoperative hearing status, tumor size and location, tumor consistency, and preoperative and intraoperative brainstem auditory evoked potentials are discussed in detail as they relate to postoperative outcome.
Insights
Tumor size significantly impacts hearing preservation in vestibular schwannoma management. Smaller tumors, especially those 1 cm or less, offer a higher chance of retaining useful hearing after treatment.
Area of Science:
- Neurosurgery
- Otolaryngology
- Audiology
Background:
- Vestibular schwannoma management goals have evolved, with hearing preservation now a key challenge.
- Lack of standardized reporting obscures the true incidence of preserved useful hearing.
Purpose of the Study:
- To identify factors influencing postoperative hearing preservation in vestibular schwannoma patients.
- To analyze outcomes in cases with directed attempts at hearing preservation.
Main Methods:
- Retrospective analysis of 56 consecutive vestibular schwannoma cases.
- Evaluation of preoperative hearing status, tumor characteristics, and intraoperative electrophysiology.
Main Results:
- In patients with good preoperative hearing, tumors < 2 cm had a 52% chance of hearing preservation.
- Tumors ≤ 1 cm offered an 83% chance of preserving good hearing.
Conclusions:
- Preoperative hearing, tumor size, and location are critical for successful hearing preservation.
- Tumor consistency and auditory evoked potentials also correlate with postoperative hearing outcomes.