Commentary “Hearing Improvement after Resection of a Large Jugular Foramen Schwannoma: Case Report”

The authors report a large nonacoustic cerebellopontine angle (CPA) neuroma, which was removed with remarkable recovery of speech discrimination. They speculate that this is due to removal of pressure on the brainstem with reactivation of more central auditory pathways. Although interesting, there are few data to support this theory. The cochlear nerve was also stretched over the top of the tumor and could have been a second site of compression along with the brainstem. Auditory brainstem audiometry was not performed so there are no data to support the site of lesion; therefore, I believe this theory must remain speculation.

This case does show the importance of attempting hearing preservation in nonacoustic CPA tumors. Primary epidermoids of the CPA are notorious for producing poor speech discrimination out of proportion to pure-tone loss. Often, speech discrimination will recover when these tumors are removed. Removal of meningiomas may also result in hearing improvement. The overall success rate for removal of nonacoustic CPA tumors is superior to results with similar-sized acoustic neuromas. The authors are to be congratulated for an excellent outcome with this very large tumor.