Download PDF
J Neurol Surg B Skull Base 2019; 80(02): 149-155
DOI: 10.1055/s-0038-1677550
Invited Review
Georg Thieme Verlag KG Stuttgart · New York

Hearing Preservation in Vestibular Schwannoma Surgery

Joe Saliba
1   Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, California, United States
,
Rick A. Friedman
1   Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, California, United States
,
Roberto A. Cueva
2   Department of Otolaryngology - Head and Neck Surgery, Southern California Kaiser Permanente Medical Group, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

18 April 2018

09 December 2018

Publication Date:
10 January 2019 (online)

Also available at
    Permissions and Reprints

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
 

  • References

  • 1 Battaglia A, Mastrodimos B, Cueva R. Comparison of growth patterns of acoustic neuromas with and without radiosurgery. Otol Neurotol 2006; 27 (05) 705-712
    CrossrefPubMedGoogle Scholar
  • 2 Stangerup S-E, Cayé-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
    CrossrefPubMedGoogle Scholar
  • 3 Stangerup S-E, Cayé-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 2012; 45 (02) 257-268 , vii –vii
    CrossrefPubMedGoogle Scholar
  • 4 Stangerup S-E, Thomsen J, Tos M, Cayé-Thomasen P. Long-term hearing preservation in vestibular schwannoma. Otol Neurotol 2010; 31 (02) 271-275
    CrossrefPubMedGoogle Scholar
  • 5 Coughlin AR, Willman TJ, Gubbels SP. Systematic review of hearing preservation after radiotherapy for vestibular schwannoma. Otol Neurotol 2018; 39 (03) 273-283
    CrossrefPubMedGoogle Scholar
  • 6 Arts HA, Telian SA, El-Kashlan H, Thompson BG. Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach. Otol Neurotol 2006; 27 (02) 234-241
    CrossrefPubMedGoogle Scholar
  • 7 Kutz Jr JW, Scoresby T, Isaacson B. , et al. Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma. Neurosurgery 2012; 70 (02) 334-340 , discussion 340–341
    CrossrefPubMedGoogle Scholar
  • 8 Yamakami I, Yoshinori H, Saeki N, Wada M, Oka N. Hearing preservation and intraoperative auditory brainstem response and cochlear nerve compound action potential monitoring in the removal of small acoustic neurinoma via the retrosigmoid approach. J Neurol Neurosurg Psychiatry 2009; 80 (02) 218-227
    CrossrefPubMedGoogle Scholar
  • 9 Sameshima T, Fukushima T, McElveen Jr JT, Friedman AH. Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach. Neurosurgery 2010; 67 (03) 640-644 , discussion 644–645
    CrossrefPubMedGoogle Scholar
  • 10 Pinna MH, Bento RF, Neto Rde B. Vestibular schwannoma: 825 cases from a 25-year experience. Int Arch Otorhinolaryngol 2012; 16 (04) 466-475
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Sidman JD, Carrasco VN, Whaley RA, Pillsbury III HC. Gadolinium. The new gold standard for diagnosing cerebellopontine angle tumors. Arch Otolaryngol Head Neck Surg 1989; 115 (10) 1244-1247
    CrossrefPubMedGoogle Scholar
  • 12 Cueva RA. Auditory brainstem response versus magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss. Laryngoscope 2004; 114 (10) 1686-1692
    CrossrefPubMedGoogle Scholar
  • 13 Nguyen QT, Wu AP, Mastrodimos BJ, Cueva RA. Impact of fundal extension on hearing after surgery for vestibular schwannomas. Otol Neurotol 2012; 33 (03) 455-458
    CrossrefPubMedGoogle Scholar
  • 14 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
    CrossrefPubMedGoogle Scholar
  • 15 Woodson EA, Dempewolf RD, Gubbels SP. , et al. Long-term hearing preservation after microsurgical excision of vestibular schwannoma. Otol Neurotol 2010; 31 (07) 1144-1152
    CrossrefPubMedGoogle Scholar
  • 16 Nelson RF, Hansen MR, Gantz BJ. Hearing preservation surgery for vestibular schwannomas. Curr Otorhinolaryngol Rep 2014; 2 (04) 235-241
    CrossrefPubMedGoogle Scholar
  • 17 Jackson LE, Roberson Jr JB. Acoustic neuroma surgery: use of cochlear nerve action potential monitoring for hearing preservation. Am J Otol 2000; 21 (02) 249-259
    CrossrefPubMedGoogle Scholar
  • 18 Suzuki M, Yamada C, Inoue R, Kashio A, Saito Y, Nakanishi W. Analysis of vestibular testing in patients with vestibular schwannoma based on the nerve of origin, the localization, and the size of the tumor. Otol Neurotol 2008; 29 (07) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 19 Tsutsumi T, Tsunoda A, Noguchi Y, Komatsuzaki A. Prediction of the nerves of origin of vestibular schwannomas with vestibular evoked myogenic potentials. Am J Otol 2000; 21 (05) 712-715
    PubMedGoogle Scholar
  • 20 Meyer TA, Canty PA, Wilkinson EP, Hansen MR, Rubinstein JT, Gantz BJ. Small acoustic neuromas: surgical outcomes versus observation or radiation. Otol Neurotol 2006; 27 (03) 380-392
    CrossrefPubMedGoogle Scholar
  • 21 Jacob A, Robinson Jr LL, Bortman JS, Yu L, Dodson EE, Welling DB. Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope 2007; 117 (12) 2087-2092
    CrossrefPubMedGoogle Scholar
  • 22 Yates PD, Jackler RK, Satar B, Pitts LH, Oghalai JS. Is it worthwhile to attempt hearing preservation in larger acoustic neuromas?. Otol Neurotol 2003; 24 (03) 460-464
    CrossrefPubMedGoogle Scholar
  • 23 Brackmann DE, Owens RM, Friedman RA. , et al. Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol 2000; 21 (03) 417-424
    CrossrefPubMedGoogle Scholar
  • 24 Mohr G, Sade B, Dufour J-J, Rappaport JM. Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling. J Neurosurg 2005; 102 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 25 Thedinger BA, Cueva RA, Glasscock III ME. Treatment of an acoustic neuroma in an only-hearing ear: case reports and considerations for the future. Laryngoscope 1993; 103 (09) 976-980
    PubMedGoogle Scholar
  • 26 Arístegui M, Denia A. Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of two cases (neurofibromatosis type 2 and unilateral vestibular schwannoma). Otol Neurotol 2005; 26 (02) 205-210
    CrossrefPubMedGoogle Scholar
  • 27 Goddard JC, Schwartz MS, Friedman RA. Fundal fluid as a predictor of hearing preservation in the middle cranial fossa approach for vestibular schwannoma. Otol Neurotol 2010; 31 (07) 1128-1134
    CrossrefPubMedGoogle Scholar
  • 28 Youssef AS, Downes AE. Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus 2009; 27 (04) E9
    CrossrefPubMedGoogle Scholar
  • 29 Cueva RA. Preoperative, intraoperative, and postoperative auditory evaluation of patients with acoustic neuroma. Otolaryngol Clin North Am 2012; 45 (02) 285-290 , vii –vii
    CrossrefPubMedGoogle Scholar
  • 30 Danner C, Mastrodimos B, Cueva RA. A comparison of direct eighth nerve monitoring and auditory brainstem response in hearing preservation surgery for vestibular schwannoma. Otol Neurotol 2004; 25 (05) 826-832
    CrossrefPubMedGoogle Scholar
  • 31 Mamikoglu B, Esquivel CR, Wiet RJ. Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors. Arch Otolaryngol Head Neck Surg 2003; 129 (04) 429-431
    CrossrefPubMedGoogle Scholar
  • 32 Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 1966; 38 (04) 352-356
    CrossrefPubMedGoogle Scholar