2026 Proffered Presentations
S068: STABILITY OF HEARING FUNCTION AFTER MIDDLE FOSSA CRANIOTOMY FOR SPORADIC VESTIBULAR SCHWANNOMA
Maya Harary1; Anna La Dine2; Sudhir Manickavel3; William Slattery3; Gregory P Lekovic1; 1UCLA; 2Campbell University; 3The House Institute
Objective: To evaluate the long-term stability of hearing function after middle fossa craniotomy (MFC) for sporadic vestibular schwannoma (VS), and to characterize which patients maintain serviceable hearing over years of follow-up.
Methods: We retrospectively reviewed prospectively collected data in 129 consecutive patients undergoing MFC for sporadic VS at a single institution. To be included, patients were required to have at least two of three postoperative audiometric assessments: immediate postoperative, 1-year, or late (≥2 years). Audiometric outcomes were classified by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) hearing classes. Serviceable hearing was defined as class A or B. Median timing of follow-up evaluations was 12.0 months (IQR 10.0–14.0) for the 1-year timepoint and 33.0 months (IQR 20.0–48.5) for the late timepoint. The “last” timepoint was defined as the latest available audiogram for each patient, which could represent either the 1-year or late evaluation depending on clinical follow-up. Stability of hearing preservation was assessed by stratifying patients by their initial postoperative hearing class and tracking class transitions at subsequent timepoints. Statistical analysis was done in R in R (ver. 4.5.1).
Results: The cohort included 71 women (55%) and 58 men (45%), with a mean age of 51.4 years (SD 10.4). Median tumor size was 10 mm [IQR 8–12]. Most patients (92.2%) presented with serviceable hearing (AAO-HNS A/B). Immediately postoperatively, serviceable hearing was preserved in 72% of patients (33.3% class A, 38.8% class B of whole cohort). Patients with serviceable hearing immediately postop (n=93) had durable function (Table 1). At 1 year, 89.8% of these remained serviceable (42.0% A, 47.8% B); at late follow-up, 76.0% were serviceable (21.7% A, 54.3% B). Overall, 85% of patients with early post-operative serviceable hearing maintained that function by last follow up (Figure 1). Similarly, patients with non-serviceable hearing immediately postop (n=36) also had durable dysfunction, though some improvement was surprisingly seen in select cases. Overall, at last follow-up 16.7% (5/36) of patients with initially non-serviceable hearing had now class A/B hearing. In sum, functional recovery, though possible, was rare, and most patients with non-functional hearing after surgery remained so at last follow-up.
Conclusions: This large single-institution series of MFC for sporadic VS, demonstrates that hearing preserved immediately after surgery is generally durable across years of follow-up in accordance with the literature in smaller cohorts. Patients with class A or B hearing postoperatively overwhelmingly maintained serviceable hearing, while those with early nonfunctional hearing rarely regained it. Defining “last follow-up” as the latest available audiogram (1-year or late) reflects real-world variability in surveillance, but still shows sustained preservation. These results suggest that MFC not only achieves immediate hearing preservation but also offers long-term durability superior to observation or radiosurgery, where progressive decline is typical.
Table 1
Figure 1
