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Hearing preservation following microsurgical resection of large vestibular schwannomas.
MedLine Citation:
PMID:  21164374     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Hearing, which is often still clinically useful at presentation even with larger tumors, is a major determinant of quality of life in vestibular schwannoma patients. OBJECTIVE:: To present the hearing preservation rate for our surgical series of large (≥3 cm) vestibular schwannomas (VSs), and identify possible clinical or radiologic predictors of hearing preservation. METHODS:: From April 2003 to March 2009, 192 patients underwent resection of a VS, including 46 large (≥3 cm) tumors, of which 28 had serviceable hearing pre-operatively. 6/28 patients (21.4%) had preserved hearing post-operatively. RESULTS:: Mean tumor diameter was 3.6 cm (range 3.0 - 5.0 cm) and tumor volume was 17.2 cc (range 6.9 - 45.2 cc). For patients with grade A Sanna-Fukushima hearing, the hearing preservation rate was 4/11 (36.4%). Complete resection was achieved in 6/6 cases with hearing preservation (41/47 for all patients). 6/6 patients with preserved hearing had a CSF cleft in the internal auditory canal (IAC), versus 9/16 patients without pre-operative hearing and 9/20 for patients with serviceable hearing but lost post-operatively (P = 0.045). 6/6 patients with preserved hearing had <35% of the tumor anterior to the longitudinal axis of the IAC, versus 13/20 in the serviceable hearing but lost group (P=0.036) CONCLUSION:: Our series demonstrates hearing preservation is possible for large VS and should be attempted in all cases with pre-operative hearing. The quality of pre-operative hearing, a CSF cleft at the apex of the IAC, and a smaller proportion of tumor anterior to the IAC were positively associated with hearing preservation.
Authors:
Salvatore Di Maio; A Daniel Malebranche; Brian Westerberg; Ryojo Akagami
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-15
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; 2Division of Otolaryngology, Department of Surgery, St. Paul's Rotary Hearing Clinic, University of British Columbia, Vancouver, British Columbia, Canada.
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