gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Long-term results in vestibular schwannoma surgery for hearing preservation: a single center experience

Meeting Abstract

  • Aikaterini Patrona - Neurochirugie, Klinikum Fulda gAG
  • Erich Hofmann - Neuroradiologie, Klinikum Fulda gAG
  • Konrad Schwager - Hals-Nasen-Ohren-Heilkunde, Klinikum Fulda gAG
  • Robert Behr - Neurochirugie, Klinikum Fulda gAG

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.10.02

doi: 10.3205/13dgnc358, urn:nbn:de:0183-13dgnc3589

Published: May 21, 2013

© 2013 Patrona et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The incidence of vestibular schwannomas (VS) in patients with serviceable hearing is increasing. The attempt to preserve functional hearing has become the next step in all current treatment modalities and remains a challenging problem. The authors review the long-term results of conjoint surgery (neurosurgeon/ENT) of VSs, in which hearing preservation was a goal.

Method: A total of 174 patients underwent conjoined surgical removal of VSs by a team of ENT's and neurosurgeons between 2001 and 2009 via the middle fossa or retrosigmoid approach. The long-term results involving 28 patients with serviceable preoperative hearing were reviewed. Patients with neurofibromatosis 2 were excluded. Pre- and postoperative audiometry, as a speech discrimination score (SDS) and pure tone threshold average (PTA), and intraoperative auditory brain stem potentials were performed, and analyzed. Hearing was classified according to the Gardner and Robertson Scale preoperatively, at discharge, a year after surgery and at the last recorded follow-up (mean follow-up of 7.3 years). In addition, facial nerve outcomes were assessed. Multiplanar MRI with and without contrast enhancement was used to evaluate tumor size, resection degree and long term tumour control.

Results: All 28 patients (13 men and 15 women with a mean age of 53.6 years) had complete sets of audiometric data and were stratified into Gardner Robertson Class I and II preoperatively. The tumours were classified based on the largest extrameatal diameter. The majority of the cases involved small and medium tumours (92.8%). 26 tumours were totally removed, 2 had near-total removal, without recurrence or progression in the follow-up. The cochlear and facial nerves were anatomically preserved in all cases. Twelve patients (42.8%) preserved functional postoperative hearing, 25% had serviceable hearing a year after resection with no change in the further follow-up. Excellent/good facial function (House and Brackmann grade1-2) was found in 27 of 28 patients at one year after surgery. There was no mortality. Complications included 3 cases of CSF leakage, and one case of subdural hematoma.

Conclusions: Hearing preservation surgery involves a loss of hearing in both the short- and long-term, but within acceptable rates considering the current choices of treatment. Maintenance of surgical expertise leads to very low complication rates, high rates of excellent/good facial nerve outcome, and a tumour control, which cannot be achieved by other modalities.