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Hearing preservation after removal of small vestibular schwannomas by retrosigmoid approach: comparison of two different ABR neuromonitoring techniques

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background and objective

Goals of small vestibular schwannoma (VS) microneurosurgery are as follows: radical resection, facial nerve (FN) preservation, and hearing preservation (HP). Microsurgical advances make HP possible in many patients with preoperative socially useful hearing (SUH). We evaluated postoperative HP in VS with maximum diameter < 2 cm monitored with two different auditory brainstem response (ABR) techniques.

Materials and methods

Twenty-eight consecutive non-randomized patients with SUH suffering from small VS underwent keyhole microneurosurgery by retrosigmoid (RS) approach. Selection criteria are as follows: speech discrimination > 50%, pure tone audiogram < 50 dB loss (50/50 criterion; AAO-HNS classes A–B), maximum diameter < 2 cm. HP was attempted with intraoperative ABR, evoked by classical Click (16 cases, group 1) and LS-CE-Chirp® stimulus (12, group 2).

Results

Mean age was 47.5 years (16–75); average maximum diameter was 1.35 cm (0.5–1.9 mm). Total and nearly total resection (> 95%) was obtained in all, as confirmed by 24–48-h postoperative enhanced MRI. Mortality and major morbidity were 0. In all cases, FN was preserved; in 3, incomplete deficit recovered within few weeks. Socially useful HP (pre- and postoperatively) was 64.3% (18 of 28): 56.25% group 1 and 75% group 2 (p = NS). Postoperative ipsilateral deafness was observed in 5 cases of group 1 (p < 0.0001). Preoperative tinnitus had negative impact on HP (p < 0.05).

Conclusions

Microsurgery can cure small growing VS with SUH. Our limited experience confirms that keyhole RS removal assisted by intraoperative ABR monitoring leads to valuable rates of SUH. LS-CE-Chirp–evoked ABRs allow a safe, effective, and clear neurophysiological feedback and are faster and, thus, more useful than the Click-ABR.

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Authors and Affiliations

  1. Department of Surgical Specialties, Division of Neurosurgery and Unit of Neurophysiopathology, San Filippo Neri Hospital/ASLRoma1, Via Reno 14, 00198, Rome, Italy

    Luciano Mastronardi, Ettore Di Scipio, Guglielmo Cacciotti, Raffaelino Roperto & Carlo Giacobbo Scavo

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  1. Luciano Mastronardi
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  2. Ettore Di Scipio
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  3. Guglielmo Cacciotti
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  4. Raffaelino Roperto
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  5. Carlo Giacobbo Scavo
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Correspondence to Ettore Di Scipio.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Tumor - Schwannoma

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Mastronardi, L., Di Scipio, E., Cacciotti, G. et al. Hearing preservation after removal of small vestibular schwannomas by retrosigmoid approach: comparison of two different ABR neuromonitoring techniques. Acta Neurochir 161, 69–78 (2019). https://doi.org/10.1007/s00701-018-3740-4

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  • DOI: https://doi.org/10.1007/s00701-018-3740-4

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