title: Hearing preservation after microsurgical resection of large vestibular schwannomas.
abstract: 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 (VS) patients.
  
  
  OBJECTIVE
  To present the hearing preservation rate after surgery in patients with large (>or=3 cm) VSs and identify clinical or radiologic predictors of hearing preservation.
  
  
  METHODS
  From April 2003 to March 2009, 192 patients underwent resection of a VS, including 46 large (>or=3 cm) tumors, of whom 28 had serviceable hearing preoperatively. Six of 28 patients (21.4%) had preserved hearing postoperatively.
  
  
  RESULTS
  Mean tumor diameter was 3.6 cm (range, 3.0-5.0 cm) and tumor volume was 17.2 mL (range, 6.9-45.2 mL). For patients with grade A Sanna-Fukushima hearing, the hearing preservation rate was 4 of 11 (36.4%). Complete resection was achieved in 6 of 6 cases with hearing preservation (41/47 for all patients). Six of 6 patients with preserved hearing had a cerebrospinal fluid cleft in the internal auditory canal (IAC) compared with 9 of 16 patients without preoperative hearing and 9 of 20 for patients with serviceable hearing that was lost postoperatively (P=.045). Six of 6 patients with preserved hearing had less than 35% of the tumor anterior to the longitudinal axis of the IAC compared with 13 of 20 in the serviceable hearing that was lost group (P=.036).
  
  
  CONCLUSIONS
  Our series demonstrates hearing preservation is possible for patients with large VSs and should be attempted in all patients with preoperative hearing. The quality of preoperative hearing, a cerebrospinal fluid cleft at the apex of the IAC, and a smaller proportion of tumor anterior to the IAC were positively associated with hearing preservation.
authors.affiliation: Department of Surgery, Vancouver General Hospital, University of British Columbia, Vanvouver, British Columbia, Canada.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Maio
authors.forename: A Daniel
authors.initials: AD
authors.lastname: Malebranche
authors.forename: Brian
authors.initials: B
authors.lastname: Westerberg
authors.forename: Ryojo
authors.initials: R
authors.lastname: Akagami
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000453:epidemiology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D013506:Otologic Surgical Procedures / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult