Although the outcome of facial and cochlear nerve function is different in CPA meningiomas, depending on the topographic classification of these tumors, preservation of the cochlear nerve is possible in every tumor group and should be attempted in every patient with CPA meningioma. It has to be kept in mind that recovery of hearing was also observed in patients with preoperative profound hearing deficits.

Meningiomas of the CPA involving the IAC require special surgical management. Dural involvement of the IAC requires opening by using a diamond drill, a procedure that does not influence cranial nerve outcome. The increased rate of cranial nerve morbidity is attributed to the infiltrative behavior of these meningiomas. If affected nerve segments have to be sacrificed, immediate reconstruction enables satisfactory long-term results.

The presence and absence of ABRs during surgery for CPA meningiomas reliably predicted the presence and absence of postoperative auditory function. Intermittent deterioration of ABRs may result in postoperative deafness, depending on the duration of these events during surgery. Improvements in hearing are only seen when the ABRs are stable for amplitudes and latencies throughout surgery.