Retrosigmoid Revision Resection of Vestibular Schwannoma after Prior Middle Cranial Fossa Resection with Hearing Preservation

Objective: Hearing preservation has long been held as a metric of success with resection of vestibular schwannoma resection. Arguably, the middle cranial fossa approach (MCF) offers the best chance at favorable hearing results. We present a case in which a patient developed recurrence of a vestibular schwannoma after primary resection with a MCF approach at an outside instituion. A revision retrosigmoid was performed with gross-total resection; the patient's hearing was found to be at her preoperative baseline with grade I House–Brackmann facial nerve function. This case demonstrates the possibility of hearing preservation in revision skull base resection.

Case Report: Here, we present the case of a 58-year-old female patient who presented 8 years’ status post–gross-total resection of right-sided vestibular schwannoma by MCF at an outside institution. A 3.5-mm recurrent tumor was seen in the right IAC on MRI; it was stable on imaging for several years. In August 2018, 10 years’ postprimary resection, MRI showed growth of her residual tumor to a size of 6 mm × mm 5 × 5 mm. Follow-up MRI 2 years later in December 2020, showed additional growth of measuring 7.2 mm × 5.4 mm axial and 8 mm × 6.5 mm coronal in the right IAC. The patient was offered continued observation and radiosurgery. After consultation, the patient desired surgical resection. We discussed both revision MCF and retrosigmoid resection. The audiogram done prior to the revision surgery showed AAO-HNS class A hearing bilaterally. Preoperative physical examination demonstrated grade-I facial nerve function. Retrosigmoid approach was taken to access the right IAC, and complete resection of the tumor was achieved (tumor measured 9 mm × 7 mm × 4 mm). Postoperative audiogram demonstrated AAO-HNS class A hearing in the operative ear, and physical examinations showed grade-I facial nerve function.

Conclusion: Hearing preservation surgery, while often offered for primary surgical resection, is rarely, if ever, considered for revision surgery. However, this case highlights that revision hearing preservation surgery may be an option in selected patients while maintaining normal facial function as well.

Publication History

Article published online:
15 February 2022