Hearing preservation in vestibular schwannoma surgery: indications, techniques and results in the literature since 1990

Many authors have recently reported hearing preservation for approximately two-thirds of acoustic neuroma patients. The results have driven them to re commend early surgery for all patients whose hearing might be saved. Invers ely, other authors advocate that MRI-screening may be beneficial in some pa tients and suggest surgery only in case of tumor growth or progressive hear ing loss. In order to facilitate therapeutic decision making, we reviewed the techniq ues and results in the main papers dealing with hearing preservation in the course of acoustic neuroma surgery published since 1990. This analysis sho wed that the average percentage of useful hearing preservation is about 31 %. It is however difficult to compare the different series due to the diffe rent methodologies used This emphasizes the need for standardization of hea ring selection and reporting criteria to a) identify factors predictive of success (tumor characteristics, preoperative hearing, monitoring, surgical pathways), and b) elaborate well accepted decisional guidelines (early surg ery or MRI screening), notably for small and non-symptomatic tumors which s how increasing prevalence.