Hearing preservation in acoustic tumor surgery.

Preservation of hearing is a realistic goal, possible through the retrosigmoid or middle fossa surgical approaches. The best candidates have small tumors and good preoperative hearing. Preoperative ABR, ENG, and imaging characteristics may help prognosticate chances for hearing preservation. Hearing rarely improves after surgery, and some have noted a decline in the preserved hearing over time. With the introduction of gadolinium-enhanced magnetic resonance imaging, a larger number of small acoustic tumors are being diagnosed before hearing has been significantly affected. These patients benefit from this early diagnosis and are the best candidates for hearing preservation surgery.