Late failure rate of hearing preservation after middle fossa approach for resection of vestibular schwannoma.

OBJECTIVE

To explore the long-term hearing results after a middle fossa approach for resection of vestibular schwannoma.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

All patients undergoing a middle fossa approach for resection of vestibular schwannoma at a single institution with intent to preserve hearing between December 1989 and December 2009 were included in the study population.

INTERVENTIONS

Standard middle fossa approach for resection of vestibular schwannoma, magnetic resonance imaging (MRI), and audiogram.

MAIN OUTCOME MEASURES

Recurrence of tumor as evaluated by MRI and hearing results as measured by serial audiograms.

RESULTS

Seventy-eight patients were identified who met study criteria. Fifty-one (65%) of the 78 patients had usable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] class A or B) postoperatively. Forty-four patients with successful hearing preservation had follow-up beyond their initial postoperative visit. Five (11%) of the 44 patients showed late degradation to nonserviceable hearing (AAO-HNS class C or D) over a mean follow-up of 4.0 years. Kaplan-Meier estimate of preservation of class A or B hearing at 10 years was 72%. Of the five patients with late degradation in hearing, 2 were found to have recurrences of their original tumor on MRI. There were 5 confirmed recurrences in the total study population.

CONCLUSION

Late degradation of hearing was an infrequent occurrence after initially successful hearing preservation. When hearing degradation did occur, there seemed to be a correlation with tumor recurrence.