Middle fossa approach for resection of vestibular schwannoma:  impact of cochlear fossa extension and auditory monitoring on hearing preservation.
OBJECTIVE
To analyze the impact of patient selection and auditory monitoring on hearing results after middle fossa craniotomy approach for resection of a vestibular schwannoma (VS).


METHODS
Retrospective case review.


METHODS
Tertiary referral center.


METHODS
Patients undergoing a middle fossa craniotomy for resection of VS at a single institution between 1995 and 2006 were included in the study population. Patients presenting with Neurofibromatosis Type 2 or who underwent a combined approach (middle fossa and retrosigmoid) were excluded.


METHODS
Hearing preservation as measured by serial audiograms.


RESULTS
Seventy-seven patients were identified. Before excluding patients with cochlear fossa enhancement and the use of auditory monitoring, 47% of the patients maintained serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Class A or B). By selecting tumors that did not involve the cochlear fossa and using auditory monitoring, serviceable postoperative hearing was preserved in 76% of the patients.


CONCLUSIONS
Modification of our selection criteria for surgery and the use of auditory monitoring have improved our hearing results for patients undergoing a middle fossa approach for resection of VS from 47% to 76%.
Service d'Otologie et Otoneurologie, Hôpital Salengro, CHRU de Lille, France. christophe.vincent@chru-lille.fr
Christophe
C
Vincent
Nicolas-Xavier
NX
Bonne
Célia
C
Guérin
Jean-Pascal
JP
Lebreton
Marion
M
Devambez
Frédérique
F
Dubrulle
Elias
E
Haddad
Stéphane
S
Schapira
Jean-Paul
JP
Lejeune
François-Michel
FM
Vaneecloo
D000328:Adult; D000368:Aged; D001299:Audiometry; D003051:Cochlea / Q000601:surgery*; D035301:Cranial Fossa, Middle / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome