gms | German Medical Science

Introduction: In vestibular schwannoma surgery, the surgical approach influences postoperative hearing and facial nerve function. Moreover there is a correlation between hearing preservation and nerve of origin.

Methods: A retrospective chart review identified 202 patients who underwent surgical removal of Vestibular Schwannoma at our department between 2000 and 2007. Data analysis included surgical approach, nerve of origin, clinical symptoms, tumor size, facial nerve function and the results of audiometry, caloric electronystagmography and posturography.

Results: The rate of facial nerve preservation according to House-Brackmann Class 1 to 3 was 87% for the translabyrinthine, 86% for the middle fossa and 75% for the suboccipital approach. In hearing preservation surgery pursuant to the 50/50 rule, the middle fossa approach (preservation rate 65%) was superior to the suboccipital approach (preservation rate 28%). Tumors from the superior vestibular nerve showed better results for hearing preservation (73%) than schwannomas from the inferior branch (53%). Caloric electronystagmography (prediction rate 80%) and posturography (prediction rate 67%) were able to predict the nerve of origin before surgery.

Conclusion: When hearing preservation is not feasible, the translabyrinthine approach offers the best results for facial nerve preservation. Concerning hearing preservation the middle fossa approach has a better outcome than the suboccipital approach. Schwannomas from the superior vestibular nerve have greater chances for hearing preservation than tumors form the inferior vestibular nerve. Before surgery the nerve of origin can be predicted with caloric electronystagmography and posturography.