Middle fossa approach for vestibular schwannoma: Good hearing and facial nerve outcomes with low morbidity

• Published in: World neurosurgery 2016-08, Vol.92, p.37-46
• Main Authors: Raheja, Amol, MBBS, Bowers, Christian A., MD, MacDonald, Joel D., MD, Shelton, Clough, MD, Gurgel, Richard K., MD, Brimley, Cameron, BS, Couldwell, William T., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Audiometry; Cohort Studies; Cranial Fossa, Middle - surgery; Facial Nerve - physiology; Facial nerve outcome; Female; Hearing - physiology; Hearing preservation outcome; Humans; Male; Middle Aged; Middle fossa approach; Neuroma, Acoustic - diagnostic imaging; Neuroma, Acoustic - surgery; Neurosurgery; Neurosurgical Procedures - methods; Neurosurgical Procedures - standards; Treatment Outcome; Vestibular schwannoma; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.04.085

Abstract Objective The middle fossa approach (MFA) is not used as frequently as the traditional translabyrinthine and retrosigmoid approaches for accessing vestibular schwannomas (VSs). Here, MFA was used to remove primarily intracanalicular tumors in patients in whom hearing preservation is a goal of surgery. Methods The authors performed a retrospective chart review to identify consecutive adult patients who underwent MFA for VS. Demographic profile, perioperative complications, pre- and postoperative hearing, and facial nerve outcomes were analyzed with linear regression analysis to identify factors predicting hearing outcome. Results Among 78 identified patients (mean age 49 years, 53% female, mean tumor size 7.5 mm), 78% had functional hearing preoperatively (American Academy of Otolaryngology–Head and Neck Surgery class A/B). Follow-up audiological data was available for 60 patients overall (mean follow-up 15.1 months). The hearing preservation rate was 75.5% (37/49) at last known follow-up for patients with functional hearing preoperatively. Other than preoperative hearing status (p0.05). Good functional preservation of the facial nerve (House-Brackmann class I/II) was achieved in 90% of patients. The only operative complications were 3 wound infections (3.8%). Conclusion Preliminary results from this single-center retrospective study of patients undergoing MFA for resection of VS showed that good hearing preservation and facial nerve outcomes could be achieved with few complications. These results suggest that resection via the MFA is a rational alternative to watchful waiting or stereotactic radiosurgery.