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Audiovestibular results after surgery for cerebellopontine angle meningiomas
P L Grey1, D M Baguley, D A Moffat
1Department of Otoneurological and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Abstract:
Meningiomas are the second most common cerebellopontine angle (CPA) tumor. The reported rates of hearing preservation following surgical removal vary between 32% and 100%. There is only one recent report discussing vestibular function after CPA meningioma removal. In this series of 31 patients with CPA meningiomas, 16 patients had their tumors removed via the retrosigmoid approach. All 16 had audiovestibular assessment pre- and postsurgery and were the subjects of this study. Class A hearing is socially useful hearing and is defined as a pure tone average (PTA; average of 500 Hz and 1, 2 and 4 kHz) of < 30 dB and speech discrimination scores (SDS) of > 70%. Class B hearing is serviceable hearing, defined as PTA of < 50 dB and SDS of > 50%. Nine patients had class A hearing, and two had class B hearing presurgery. Socially useful hearing was preserved in six of nine (67%) patients in whom it was present before surgery, and serviceable or better hearing was preserved in eight of 11 (73%). Vestibular symptomatology and examination findings improved despite a decrease in the number of patients with intact caloric function postsurgery. Patients who retained vestibular function on caloric testing were symptomatically better than those who lost caloric function. These results confirm that excellent audiovestibular function is possible after CPA meningioma surgery.
Insights
Excellent hearing and vestibular function preservation is possible after cerebellopontine angle (CPA) meningioma surgery. This study shows good outcomes for patients undergoing tumor removal via the retrosigmoid approach.
Area of Science:
- Neurosurgery
- Audiology
- Vestibular Function
Background:
- Meningiomas are common cerebellopontine angle (CPA) tumors.
- Hearing preservation rates after CPA meningioma surgery vary widely.
- Limited recent data exists on vestibular function post-CPA meningioma removal.
Purpose of the Study:
- To assess audiovestibular function preservation after retrosigmoid approach CPA meningioma resection.
- To evaluate hearing preservation using Class A (socially useful) and Class B (serviceable) criteria.
- To analyze changes in vestibular symptoms and function post-surgery.
Main Methods:
- Retrospective analysis of 16 patients with CPA meningiomas treated via retrosigmoid approach.
- Pre- and post-operative audiovestibular assessments including pure tone average (PTA) and speech discrimination scores (SDS).
- Evaluation of vestibular symptomatology and caloric testing results.
Main Results:
- Socially useful hearing (Class A) preserved in 67% of eligible patients.
- Serviceable or better hearing (Class B) preserved in 73% of eligible patients.
- Improved vestibular symptoms post-surgery, though caloric function decreased; patients with preserved vestibular function fared better symptomatically.
Conclusions:
- The retrosigmoid approach allows for excellent audiovestibular function preservation in CPA meningioma surgery.
- Good hearing and vestibular outcomes are achievable, emphasizing the importance of pre-operative function.
- Further research into vestibular function preservation is warranted.