Abstract
Modern imaging techniques allow early detection of small vestibular schwannomas (VSs)
with minimal or no hearing impairment. While controversy surrounds the management
of these tumors, given their benign nature and unpredictable natural history, microsurgical
excision is the only modality that offers the opportunity to cure the tumor and preserve
hearing. Hearing preservation in VS surgery may be accomplished via the middle fossa
or retrosigmoid approaches. Appropriate patient selection and surgical approach is
critical in achieving the best hearing outcomes. This article highlights the preoperative
assessment, patient selection and prognostic factors, intraoperative monitoring of
hearing, and surgical approaches to optimize hearing preservation during VS removal.
Keywords
vestibular schwannoma - hearing preservation - skull base - retrosigmoid - middle
cranial fossa
