Document Detail


Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma.
MedLine Citation:
PMID:  21826031     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: The incidence of small vestibular schwannomas in patients with serviceable hearing is increasing due to the widespread use of MRI. The middle fossa approach provides the patient with an opportunity for tumor removal with hearing preservation. OBJECTIVE:: To determine the rate of hearing preservation and facial nerve outcomes after removal of a vestibular schwannoma using the middle fossa approach. METHODS:: A retrospective case review at a tertiary, academic medical center was performed identifying patients from 1998 through 2008 that underwent removal of a vestibular schwannoma by the middle fossa approach. Preoperative and postoperative audiograms were compared to determine hearing preservation rates. In addition, facial nerve outcomes at last follow-up were recorded. RESULTS:: Forty-six patients underwent a middle fossa craniotomy for the removal of a vestibular schwannoma. Of the 38 patients that had class A or class B hearing preoperatively, 24 (63.2%) retained class A or B hearing and 29 (76.3%) retained class A, B, or C hearing. When tumors were 10 mm or less in patients with class A or B preoperative hearing, 22 of 30 patients (73.3%) retained class A or B hearing. When the tumor size was greater than 10 mm in patients with class A or B preoperative hearing, two of eight patients (25%) retained class A or B hearing. At most recent follow-up, 76.1% of patients had HB grade I facial function, 13.0% had HB grade II facial function, and 10.9% had HB grade III facial function. CONCLUSION:: Hearing preservation rates are excellent using the middle fossa approach, especially for smaller tumors. No patient experienced long-term facial nerve function worse than House-Brackmann grade III.
Authors:
Joe Walter Kutz; Tyler Scoresby; Brandon Isaacson; Bruce E Mickey; Christopher J Madden; Samuel L Barnett; Caetano Coimbra; Linda S Hynan; Peter S Roland
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-05
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*University of Texas Southwestern Medical Center, Department of Otolaryngology, 5323 Harry Hines Blvd., Dallas, TX 75390; †University of Texas Southwestern Medical Center, Department of Neurological Surgery, 5323 Harry Hines Blvd., Dallas, TX 75390; ^Baylor University Medical Center, 3600 Gaston Av., Wadley Tower, Suite 1158, Dallas, TX 75246; **University of Texas Southwestern Medical Center, Department of Clinical Sciences (Biostatistics) and Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390.
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