Objective: To compare hearing preservation and facial nerve function outcomes in patients undergoing vestibular schwannoma surgery performed using either the middle cranial fossa approach (MCFA) or the retrosigmoid approach (RSA). Materials and Methods: A review of the medical records of patients diagnosed with vestibular schwannoma who underwent surgical tumor removal in a single reference center via the MCFA or the RSA between January 1988 and December 2008 was conducted. Results: During this period, 90 patients underwent surgery via the MCFA while 86 patients received surgical treatment via the RSA. Of the patients subjected to the MCFA, 80.7% were characterized by a House-Brackmann (HB) grade I or II outcome, whereas 96.5% of patients undergoing the RSA were characterized by a HB grade I or II outcome (p = 0.001). This difference appeared only for extrameatal tumors when we compared size-matched tumors (58.3% MCFA vs. 98% RSA; p = 0.0006). There was no statistically significant difference in the hearing outcomes upon consideration of hearing preservation as characterized by the modified Sanna classification system involving classes A and B (18.9% MCFA vs. 10.6% RSA; p = 0.122). Conclusion: No statistically significant difference in hearing preservation was identified when comparing tumors operated upon via the MCFA versus the RSA. However, our results indicate that a higher risk of facial nerve function impairment exists if the surgery is performed via the MCFA under circumstances where the tumor extends to the cerebellopontine angle.

AAO-HNS: Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma) – American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995;113:179–180.
Arriaga MA, Chen DA: Facial function in hearing preservation acoustic neuroma surgery. Arch Otolaryngol Head Neck Surg 2001;127:543–546.
Arts HA, Telian SA, El-Kashlan H, Thompson BG: Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach. Otol Neurotol 2006;27:234–241.
Baumann I, Polligkeit J, Blumenstock G, Mauz PS, Zalaman IM, Maassen MM: Quality of life after unilateral acoustic neuroma surgery via middle cranial fossa approach. Acta Otolaryngol 2005;125:585–591.
Brackmann DE, Owens RM, Friedman RA, Hitselberger WE, De la Cruz A, House JW, Nelson RA, Luxford WM, Slattery WH 3rd, Fayad JN: Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol 2000;21:417–424.
Briggs RJ, Fabinyl G, Kaye AH: Current management of acoustic neuromas: review of surgical approaches and outcomes. J Clin Neurosci 2000;7:521–526.
Chee GH, Nedzelski JM, Rowed D: Acoustic neuroma surgery: the results of long-term hearing preservation. Otol Neurotol 2003;24:672–676.
Cohen NL: Retrosigmoid approach for acoustic tumor removal. Neurosurg Clin N Am 2008;19:239–250.
Danner C, Mastrodimos B, Cueva RA: A comparison of direct eighth nerve monitoring and auditory brainstem response in hearing preservation surgery for vestibular schwannoma. Otol Neurotol 2004;25:826–832.
Darwish BS, Bird PA, Goodisson DW, Bonkowisk JA, MacFarlane MR: Facial nerve function and hearing preservation after retrosigmoid excision of vestibular schwannoma: Christchurch Hospital experience with 97 patients. ANZ J Surg 2005;75:893–896.
Elsmore AJ, Mendoza ND: The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg 2002;16:448–455.
Falcioni M, Romano G, Aggarwal N, Sanna M: Cerebrospinal fluid leak after retrosigmoid excision of vestibular schwannomas. Otol Neurotol 2008;29:384–386.
Gjuric M, Wigand ME, Wolf SR: Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol 2001;22:223–231.
Goddard JC, Schwartz MS, Friedman RA: Fundal fluid as a predictor of hearing preservation in the middle cranial fossa approach for vestibular schwannoma. Otol Neurotol 2010;31:1126–1134.
Hillman T, Chen DA, Arriaga MA, Quigley M: Facial nerve function and hearing preservation acoustic tumor surgery: does the approach matter? Otolaryngol Head Neck Surg 2010;142:115–119.
Holsinger FC, Coker NJ, Jenkins HA: Hearing preservation in conservation surgery for vestibular schwannoma. Am J Otol 2000;21:695–670.
House JW, Brackman DE: Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–147.
House WF, Shelton C: Middle fossa approach for acoustic tumor removal. Neurosurg Clin N Am 2008;19:279–288.
Irving RM, Jackler RK, Pitts LH: Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches. J Neurosurg 1998;88:840–845.
Iyer AP, Gunn R, Sillars H: Quality of life after vestibular schwannoma surgery: does hearing preservation make a difference? J Laryngol Otol 2010;124:370–373.
Jacob A, Robinson LL Jr, Bortman JS, Yu L, Edward E, Dodson EE, Welling DB: Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope 2007;117:2087–2092.
Jaisinghani VJ, Levine SC, Nussbaum E, Haines S, Lindgren B: Hearing preservation after acoustic neuroma surgery. Skull Base Surg 2000;10:141–147.
Kanzaki J, Tos M, Sanna M, Moffat DA: New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003;24:642–649.
Khrais T, Romano G, Sanna M: Nerve origin of vestibular schwannoma: a prospective study. J Laryngol Otol 2008;122:128–131.
Khrais T, Sanna M: Hearing preservation surgery in vestibular schwannoma. J Laryngol Otol 2006;120:366–370.
Kobayashi M, Tsunoda A, Komatsuzaki A, Yamada I: Distance from acoustic neuroma to fundus and a postoperative facial palsy. Laryngoscope 2002;112:168–171.
Kumon Y, Sakaki S, Kohno K, Ohta S, Kakagawa K, Ohue S, Murakami S, Yanagihara N: Selection of surgical approaches for small acoustic neurinomas. Surg Neurol 2000;53:52–60.
Lassaletta L, Fontes L, Melcon E, Sarria MJ, Gavilan J: Hearing preservation with retrosigmoid approach for vestibular schwannoma: myth or reality? Otolaryngol Head Neck Surg 2003;129:397–401.
Magnan J, Barbieri M, Mora R, Murphy S, Meller R, Bruzzo M, Chays A: Retrosigmoid approach for small and medium-size acoustic neuromas. Otol Neurotol 2002;23:141–145.
Mamikoglu B, Esquivel CR, Wiet RJ: Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-size tumors. Arch Otolaryngol Head Neck Surg 2003;129:429–431.
Mangham CA: Retrosigmoid versus middle fossa surgery for small vestibular schwannomas. Laryngoscope 2004;114:1455–1461.
Maw AR, Coakham HB, Ayoub O, Butler SR: Hearing preservation and facial nerve function in vestibular schwannoma surgery. Clin Otolaryngol Allied Sci 2003;28:252–256.
Meyer TA, Canty PA, Wilkinson EP, Hansen MR, Rubinstein JT, Gantz BJ: Small acoustic neuromas: surgical outcomes versus observation or radiation. Otol Neurotol 2006;27:380–392.
Mohr G, Sade B, Dufour JJ, Rappaport JM: Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling. J Neurosurg 2005;102:1–5.
Moriyama T, Fukushima T, Asaoka K, Roche PH, Barrs DM, McElveen JT Jr: Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor. J Neurosurg 2002; 97:337–340.
Noudel R, Gomis P, Duntze J, Marnet D, Bazin A, Roche PH: Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches. Acta Neurochir (Wien) 2009;151:935–945.
Oghalai JS, Buxbaum JL, Pitss LH, Jackler RK: The effect of age on acoustic neuroma surgery outcomes. Otol Neurotol 2003;24:473–477.
Piccirillo E, Hiruami H, Hamada M, Russo A, De Stefano A, Sanna M: Intraoperative cochlear nerve monitoring in vestibular schwannoma surgery – does it really affect hearing outcome? Audiol Neurootol 2008;13:58–64.
Sameshima T, Fukushima T, McElveen JT Jr, Friedman A: Critical sssessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach. Neurosurgery 2010;67:640–645.
Samii M, Gerganov V, Samii A: Improved hearing preservation of hearing and facial nerve unction in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006;105:527–535.
Sanna M, Agarwal M, Jain Y, Russo A, Taibah AK: Transapical extension in difficult cerebellopontine angle tumors: preliminary report. J Laryngol Otol 2003;117:788–792.
Sanna M, Karmarkar S, Landolfi M: Hearing preservation in vestibular schwannoma surgery: fact or fantasy? J Laryngol Otol 1995;109:373–380.
Sanna M, Khrais T, Piccirillo E, Russo A, Augurio A: Hearing preservation surgery in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol 2004b;113:156–163.
Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M: Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol 2004a;25:379–386.
Sanna M, Zini C, Mazzoni A, Gandolfi A, Pareschi R, Pasanisi E, Gamoletti R: Hearing preservation in acoustic neuroma surgery: middle fossa versus suboccipital approach. Am J Otol 1987;8:500–506.
Satar B, Jackler RK, Oghalai J, Pitts LH, Yates PD: Risk-benefit analysis of using the middle fossa approach for acoustic neuromas with >10 mm cerebellopontine angle component. Laryngoscope 2002;112:1500–1506.
Satar B, Yetiser S, Özkaptan Y: Impact of tumor size on hearing outcome and facial function with the middle fossa approach for acoustic neuroma: a meta-analytic study. Acta Otolaryngol 2003;123:499–505.
Shiobara R, Ohira T, Inooue Y, Kanzaki J, Kawase T: Extended middle cranial fossa approach for vestibular schwannoma: technical note and surgical results of 896 operations. Prog Neurol Surg 2008;21:65–72.
Somers T, Casselman J, de Ceulaer G, Govaerts P, Offeciers E: Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma. Otol Neurotol 2001;22:87–94.
Staecker H, Nadol JB Jr, Ojeman R, Rooner S, McKenna MJ: Hearing preservation in acoustic neuroma surgery: middle fossa versus retrosigmoid approach. Am J Otol 2000;21:399–404.
Stidham KR, Roberson JB Jr: Hearing improvement after middle fossa resection of vestibular schwannoma. Otol Neurotol 2001;22:917–921.
Sughrue ME, Yang I, Aranda D, Kane AJ, Parsa AT: Hearing preservation rates after microsurgical resection of vestibular schwannoma. J Clin Neurosci 2010;17:1126–1129.
Thomsen J, Stougaard M, Becker M, Tos M, Jennum P: Middle fossa approach in vestibular schwannoma surgery. Postoperative hearing preservation and EEG changes. Acta Otolaryngol 2000;120:517–522.
Veronezi RJ, Fernandes YB, Borges G, Ramina R: Long-term facial nerve clinical evaluation following vestibular schwannoma surgery. Arq Neuropsiquiatr 2008;66:194–198.
Woodson EA, Dempewolf RD, Gubbels SP, Porter AT, Oleson JJ, Hansen MR, Gantz BJ: Long-term hearing preservation after microsurgical excision of vestibular schwannoma. Otol Neurotol 2010;31:1144–1152.
Yamakami I, Yoshinori H, Saeki N, Wada M, Oka N: Hearing preservation and intraoperative auditory brainstem response and cochlear nerve compound action potential monitoring in the removal of small acoustic neurinoma via the retrosigmoid approach. J Neurol Neurosurg Psychiatry 2009;80:218–227.
Yang J, Grayeli AB, Barylyak R, Elgarem H, Kalamarides M, Ferrary E, Sterkers O: Functional outcome of retrosigmoid approach in vestibular schwannoma surgery. Acta Otolaryngol 2008;128:881–886.
Yates PD, Jackler RK, Satar B, Pitts LH, Oghalai JS: Is it worthwhile to attempt hearing preservation in larger acoustic neuromas? Otol Neurotol 2003;24:460–464.
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