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Hearing preservation in acoustic neuroma surgery
1National Hospital for Neurology and Neurosurgery, London, UK.
Clinical Otolaryngology and Allied Sciences
|June 1, 1994
Summary
Hearing preservation is possible in acoustic neuroma surgery. Retrosigmoid surgery achieved good hearing outcomes in 78.6% of patients with small tumors, suggesting its consideration in management.
Area of Science:
- Neurosurgery
- Audiology
- Otolaryngology
Background:
- Hearing preservation in acoustic neuroma surgery is a complex challenge with limited British literature.
- The retrosigmoid approach has been utilized for acoustic neuroma resection with the primary goal of hearing conservation.
Observation:
- A series of 24 patients undergoing retrosigmoid surgery for acoustic neuromas over nine years were analyzed.
- Pre-operative selection criteria, surgical techniques, and post-operative hearing quality were evaluated.
Findings:
- Hearing preservation was successful in 11 of 14 patients (78.6%) with small or intracanalicular tumors, achieving a mean minimum auditory threshold of 35 dB and 70% speech discrimination.
- Tumor extension into the internal auditory canal fundus was identified as a negative prognostic factor for hearing preservation.
- Complete tumor excision was achieved in all cases, with excellent facial nerve function (nearly 90% normal, 10% grade II) and minimal associated morbidity.
Implications:
- The retrosigmoid approach offers a viable option for hearing conservation in select acoustic neuroma patients.
- Careful patient selection, particularly regarding tumor size and location, is crucial for optimizing hearing preservation outcomes.
- Considering hearing conservation as a management factor for small acoustic neuromas is recommended.