Hearing preservation in solitary vestibular schwannoma surgery using the retrosigmoid approach

The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by the retrosigmoid approach at Addenbrooke's Hospital, Cambridge, during a 10-year period are presented. The hearing-preservation rate, using audiometric criteria set by others as "serviceable hearing" (Wade PJ, House W. Otolaryngol Head Neck Surg 1984;92:1184-93; Silverstein H, et al. Otolaryngol Head Neck Surg 1986;95:285-91; Cohen NL, et al. Am J Otol 1993;14:423-33) was 8% (4 of 50 cases). When the more stringent selection criteria of near-normal hearing and reporting criteria of socially useful hearing preservation (pure-tone average < 30 dB/speech discrimination score > 70%) is used, the hearing-preservation rate is 4.8% (1 of 21 cases). The only preoperative factor that may predict a favorable hearing-preservation outcome is normal auditory brain stem response morphology (Fisher's exact 5-tailed test, P < 0.001). The number of suitable candidates for hearing-preservation surgery are few. Reasonable indications for attempted vestibular schwannoma surgery with hearing preservation are discussed.