Hearing Preservation Surgery for Vestibular Schwannoma: Analysis of Mid- and Long-Term Hearing Outcomes

Introduction: Vestibular schwannoma (VS) management is decided on patients- and tumor-related factors. When hearing is preserved at diagnosis, treatment options should also aim to maintain hearing function. In small VS, observation, radiotherapy, and hearing-preserving surgery (HPS) can initially offer hearing preservation, but long-term results in the literature are sparse. The aim of the study is to define the mid and long-term audiological results in patients with VS undergoing HPS and assess the stability of preserved hearing. A systematic literature review on the topic was conducted as well.

Material and Methods: Between 2011 and 2023, a total of 47 patients with sporadic VS underwent HPS via retrosigmoid approach and retrolabyrinthine meatotomy. Twenty-one were included in the study (13 males [61.9%], mean age: 49 years), according to the inclusion criteria: postoperative hearing preservation, and audiological follow-up ≥36 months (midterm). PTA-SDT-SRT-SDS was determined, and hearing classified according to AAO-HNS and Tokyo classifications. A subgroup of 12 patients with ≥60 months of follow-up was separately evaluated. Additionally, the literature was sought for studies on long-term audiological follow-up after VS resection with hearing preservation intent. The pooled prevalence of maintaining long-term serviceable hearing was calculated.

Results: Sixteen patients (76.2%) had at 36 months AAO-HNS class A/B. Compared with the immediate postoperative results, 20 patients (95.2%) improved or maintained their hearing class. At 60-month follow-up, 66.7% patients retained class A/B. Ten patients (83.3%) improved or maintained their class. The audiometric values recorded at 2, 36 months, and at the last follow-up showed no significant changes over time (Friedman’s test). The estimated 5-year probability of maintaining serviceable hearing was 91.7% (95%CI = 53.9–98.8%). According to the literature, the prevalence of maintaining long-term serviceable hearing after HPS presented a pooled estimate of 74.5% (95% CI: 63.5–84.1%).

Conclusion: HPS for small VS demonstrated stable audiological results in the mid and long-term follow-up. Results were comparable with the current literature on the topic. HPS can be considered a valid option aiming to cure the disease and preserve patients’ hearing over the mid- and long-term follow-up.

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Artikel online veröffentlicht:
07. Februar 2025