Extended Retrolabyrinthine Approach: Results of Hearing Preservation Surgery Using a New System for Continuous Near Real-time Neuromonitoring in Patients With Growing Vestibular Schwannomas

Otol Neurotol. 2019 Jun;40(5S Suppl 1):S72-S79. doi: 10.1097/MAO.0000000000002216.

Abstract

Objective: To report hearing preservation results after retrolabyrinthine vestibular schwannoma surgery, using a new system for continuous near real-time monitoring of cochlear nerve function.

Study design: Retrospective chart review.

Setting: Tertiary referral center, University Hospital.

Patients: Thirty-one consecutive patients with growing vestibular schwannomas and opting for hearing preservation surgery.

Interventions: Tumor removal by a modified, extended retrolabyrinthine approach, using a new system for continuous near real-time monitoring of cochlear nerve function.

Main outcome measures: Pure-tone average and speech discrimination (SD) 1-year postoperative. Preservation of word recognition score class. Preservation of serviceable hearing (SD>50%).

Results: Any hearing was preserved in 83 and 69% had preserved word recognition score class or better. Serviceable hearing was preserved in 77%. SD was unchanged in 48%, improved in 21%, and poorer in 31%. Of 18 patients with potential for improvement (SD 90% or worse preoperatively), 33% improved (SD increase 10% or more).

Conclusion: The hearing preservation rate is favorable using the modified, extended retrolabyrinthine approach and a new system for continuous near real-time monitoring of cochlear nerve function for removal of growing vestibular schwannomas, as 77% preserved serviceable hearing 1 year after surgery. Hearing improved after surgery in 33%. Using the new neuromonitoring system, serviceable hearing preservation rate improved from 53 to 77% at our center.

MeSH terms

  • Adult
  • Aged
  • Female
  • Hearing
  • Humans
  • Intraoperative Neurophysiological Monitoring / methods*
  • Male
  • Middle Aged
  • Neuroma, Acoustic / surgery*
  • Neurosurgical Procedures / methods*
  • Retrospective Studies
  • Treatment Outcome*