Analysis of Hearing Preservation in Middle Cranial Fossa Resection of Vestibular Schwannoma

Objective: Describe the effect of preoperative hearing on the likelihood of hearing preservation after middle cranial fossa (MCF) approach for resection of vestibular schwannoma (VS) and the effect of hearing preservation on disease-specific quality of life (QOL). Study design: Retrospective chart review. Setting: Academic tertiary care skull base surgery program. Patients: Sixty three adult patients with preoperative word recognition score (WRS) >= 50% who underwent MCF resection of VS between 2017 and 2020. Interventions: All patients underwent MCF VS resection with attempted hearing preservation. Main outcome measures: Hearing preservation (postoperative WRS >= 50%), hearing-related Penn Acoustic Neuroma Quality of Life (PANQOL) score. Results: Sixty three patients with mean age 47.4 (+/- 9.6) years and tumor size 11.5 (+/- 0.5) mm were analyzed. Hearing was preserved (+HP) and lost (-HP) in 37 (58.7%) and 26 (41.3%) patients, respectively. Preoperatively, pure tone average audiometry was significantly lower among the +HP group (20.0 dB) versus -HP (31.0 dB, p < 0.003). WRS was higher among +HP versus -HP (94% vs. 84%, respectively; p < 0.002). Linear regression showed that intra- versus extra-canalicular tumor location, sudden hearing loss history, fundal fluid cap thickness, and tumor size had no relationship to hearing preservation outcomes. When evaluating postoperative QOL data (n = 37) hearing-related PANQOL score differed between +HP and -HP (t(35) = 2.458, p = 0.0191) groups. Conclusions: In this cohort of patients undergoing MCF resection of VS, rates of HP were higher for patients with excellent preoperative hearing. Postoperatively, +HP patients reported improved hearing-related PANQOL scores compared to -HP patients.