Hearing Outcomes after Middle Fossa or Retrosigmoid Craniotomy for Vestibular Schwannoma Tumors

Abstract

Objective The objective of this study was to evaluate hearing outcomes following middle fossa (MF) or retrosigmoid (RS) craniotomy for vestibular schwannoma (VS) removal with the goal of hearing preservation.

Design This is a retrospective series.

Setting This study was set at a skull base referral center.

Participants In this study, 377 sporadic VS patients underwent primary microsurgery for VS from 2002 to 2012 using the MF (n = 305) or RS (n = 72) approaches.

Main Outcome Measures The main outcome measures were change in pure-tone average (PTA) and word recognition score from pre- to postoperative and surgical complications.

Results Preoperative hearing did not differ between approaches. Tumors were larger in the RS group (mean = 1.78 cm) than the MF group (mean = 0.97 cm) (p ≤ 0.001). Mean times to last audiometric follow-up were MF 1.0 year and RS 0.7 years. Mean decline in hearing from preoperative to last follow-up was greater in the RS group (55.5 dB in PTA and 45.6% in discrimination) than the MF group (38.9 dB and 31.7%) (p ≤ 0.011 and 0.033, respectively). The effect of surgical approach on hearing outcome remained after controlling for tumor size. Facial nerve outcomes and cerebrospinal fluid leak rates were not significantly different.

Conclusion Loss of hearing was greater with the RS approach than the MF approach, even when accounting for differences in tumor size. Postoperative facial nerve function and other complications did not differ between approaches.

Keywords

vestibular schwannoma - acoustic neuroma - middle fossa craniotomy - retrosigmoid craniotomy - hearing preservation

Note

Eric P. Wilkinson and Daniel S. Roberts contributed equally.

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