Early and Late Postoperative Hearing Preservation in Patients with Acoustic Neuromas

Umezu, Hiromichi; Aiba, Tadashi; Tsuchida, Shoichi; Seki, Yojiro

doi:10.1097/00006123-199608000-00007

Cited by 25 publications

(11 citation statements)

References 22 publications

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“…26 Changes in hearing did not correlate with tumor size, preoperative hearing, intraoperative change in hearing, the interval between initial symptoms and surgery, sex, or age in one study, 27 and hearing at long-term follow-up was significantly better in patients with excellent preoperative hearing in another study. 28 Hearing preservation proved important and realistic in our study, too, as at 5 years after surgery it remained preserved in all patients in whom it had been preserved in the early postoperative period. A significant change was noticed in 37% of patients, and specifically at higher frequencies above 1 kHz.…”

Section: Long-term Outcomesupporting

confidence: 60%

What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

Gjuric¹,

Rudić²

2008

Skull Base

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Objectives: To analyze our own functional results to delineate a critical vestibular schwannoma size for middle cranial fossa (MCF) surgery with the best possible outcome. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Methods: Tumors were divided into intracanalicular, tumors 1 to 5, 6 to 10, and 11 to 15 mm in the cerebellopontine angle (CPA). Patients were evaluated at 2 months, 1 year, and 5 years after surgery. Results: At 1 year, HouseBrackmann score of I or II was obtained in 100% of intracanalicular and in 96%, 86%, and 85% with tumors up to 5, 10, and 15 mm in the CPA, respectively. Class I hearing was postoperatively preserved in 61%, 41%, 29%, and 20%, and measurable word recognition in 67%, 51%, 35%, and 21% of patients, respectively. Conclusion: The outcome is predominantly a function of tumor size, and these changes influence MCF surgery at an earlier stage than in the translabyrinthine or retrosigmoid approach. For the facial nerve, there is a cutoff at 5-mm extracanalicular extension. Also, chances for successful hearing preservation decrease rapidly with size, and in tumors beyond 1.5 cm are below 20%. Consequently, although an expectant policy with small tumors may be reasonable in some instances, it is not so for MCF candidates.

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Section: Long-term Outcomesupporting

confidence: 60%

What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

Gjuric¹,

Rudić²

2008

Skull Base

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“…Only four patients required hearing saving operation, of whom one achieved serviceable hearing (pure-tone average º50 dB, speech discrimination score À50%). 15) Our findings suggest that the risk of tumor recurrence after NTR is quite low. Substantial adherence of the tumor to the facial nerve presents a high risk of poor facial nerve outcome.…”

Section: Discussionmentioning

confidence: 59%

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Seol

Kim

Park

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p ＝ 0.620). However, recurrence was significantly less after NTR than STR (p ＝ 0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p ＝ 0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p ＝ 0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.

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“…Patients managed surgically also demonstrated varying long‐term audiologic outcomes. Umezu et al 11 reported on 73 patients managed by way of a suboccipital transmeatal approach. Of those patients, 51 demonstrated preoperative hearing that was Gardner‐Robertson class 3 or better.…”

Section: Discussionmentioning

confidence: 99%

“…Of those patients, 51 demonstrated preoperative hearing that was Gardner‐Robertson class 3 or better. After surgery, only 21 (41.2%) of the 51 patients retained class 1 to 3 hearing 11 . Kaylie et al 12 reported hearing outcomes on 97 patients who underwent tumor excision.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Acoustic Neuromas: Long-Term Hearing Results in Patients Managed with Fractionated Stereotactic Radiotherapy, Hearing Preservation Surgery, and Expectantly

et al. 2005

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Hearing acuity statistically worsened over the long term (P < .01) in all three groups. There was a significant proportion of patients in whom hearing deteriorated from serviceable to nonserviceable hearing (P < .01) during the follow-up interval. The decline was most significant in the groups treated with HPTES and HSR compared with the group treated expectantly (P < .05). Hearing outcomes, in our experience, continue to be poor, but this is especially so in patients treated with HPTES or HSR.

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Early and Late Postoperative Hearing Preservation in Patients with Acoustic Neuromas

Abstract: Postoperative long-term preservation of hearing is more likely if surgery is performed while the tumor is still small and hearing is still excellent. Under these circumstances, it is more likely that the early and late hearing loss will be compensated.

Cited by 25 publications

References 22 publications

What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Unilateral Acoustic Neuromas: Long-Term Hearing Results in Patients Managed with Fractionated Stereotactic Radiotherapy, Hearing Preservation Surgery, and Expectantly

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