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J Neurol Surg B Skull Base 2016; 77(03): 193-198
DOI: 10.1055/s-0035-1564054
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical and Radiographic Factors Predicting Hearing Preservation Rates in Large Vestibular Schwannomas

Daniel Mendelsohn
1   Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
,
Brian D. Westerberg
2   Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
,
Charles Dong
1   Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
,
Ryojo Akagami
1   Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
› Author Affiliations
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Publication History

09 February 2015

22 July 2015

Publication Date:
14 September 2015 (online)

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Abstract

Objectives Postoperative hearing preservation rates for patients with large vestibular schwannomas range from 0 to 43%. The clinical and radiographic factors predicting hearing preservation in smaller vestibular schwannomas are well described; however, their importance in larger tumors is unclear. We investigated factors predicting hearing preservation in large vestibular schwannomas.

Design Retrospective review.

Setting Quaternary care academic center.

Participants A total of 85 patients with unilateral vestibular schwannomas > 3 cm underwent retrosigmoid resections.

Main Outcomes Measures Preoperative and postoperative serviceable hearing rates.

Methods Clinical and radiographic data including preoperative and postoperative audiograms, preoperative symptoms, magnetic resonance imaging features, and postoperative facial weakness were analyzed.

Results Hearing was preserved in 41% of patients (17 of 42) with preoperative serviceable hearing. Hypertension and diabetes increased the likelihood of preoperative hearing loss. Preoperative tinnitus predicted a lower likelihood of hearing preservation. No radiographic factors predicted hearing preservation; however, larger tumor size, smaller fourth ventricular width, and the presence of a cerebrospinal fluid cleft surrounding the tumor predicted postoperative facial weakness.

Conclusion Systemic comorbidities may influence hearing loss preoperatively in patients with large vestibular schwannomas. The absence of tinnitus may reflect hearing reserve and propensity for hearing preservation. Preoperative radiographic features did not predict hearing preservation despite some associations with postoperative facial weakness.

Keywords

hearing preservation - microsurgery - vestibular schwannoma
 

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