title: Middle Fossa Approach for Vestibular Schwannoma: Good Hearing and Facial Nerve Outcomes with Low Morbidity.
abstract: OBJECTIVE
  The middle fossa approach (MFA) is not used as frequently as the traditional translabyrinthine and retrosigmoid approaches for accessing vestibular schwannomas (VSs). Here, MFA was used to remove primarily intracanalicular tumors in patients in whom hearing preservation is a goal of surgery.
  
  
  METHODS
  A retrospective chart review was performed to identify consecutive adult patients who underwent MFA for VS. Demographic profile, perioperative complications, pre- and postoperative hearing, and facial nerve outcomes were analyzed with linear regression analysis to identify factors predicting hearing outcome.
  
  
  RESULTS
  Among 78 identified patients (mean age, 49 years; 53% female; mean tumor size, 7.5 mm), 78% had functional hearing preoperatively (American Academy of Otolaryngology-Head and Neck Surgery class A/B). Follow-up audiologic data were available for 60 patients overall (mean follow-up, 15.1 months). The hearing preservation rate was 75.5% (37/49) at last known follow-up for patients with functional hearing preoperatively. Other than preoperative hearing status (P < 0.001), none of the factors assessed, including demographic profile, size of tumor, and fundal fluid cap, predicted hearing preservation (P > 0.05). Good functional preservation of the facial nerve (House-Brackmann class I/II) was achieved in 90% of patients. The only operative complications were 3 wound infections (3.8%).
  
  
  CONCLUSIONS
  Preliminary results from this single-center retrospective study of patients undergoing MFA for resection of VS showed that good hearing preservation and facial nerve outcomes could be achieved with few complications. These results suggest that resection via the MFA is a rational alternative to watchful waiting or stereotactic radiosurgery.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Amol
authors.initials: A
authors.lastname: Raheja
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bowers
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Joel D
authors.initials: JD
authors.lastname: MacDonald
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Clough
authors.initials: C
authors.lastname: Shelton
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Gurgel
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Brimley
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D015331:Cohort Studies; D035301:Cranial Fossa, Middle / Q000601:surgery*; D005154:Facial Nerve / Q000502:physiology*; D005260:Female; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
keywords: Facial nerve outcome; Hearing preservation outcome; Middle fossa approach; Vestibular schwannoma