Objective: To show the clinical outcome in patients with sporadic vestibula
r schwannoma (VS) operated on by the enlarged middle cranial fossa approach
(EMFA).
Study Design: Retrospective case review.
Setting: A tertiary referral center with four neurotologists experienced in
EMFA surgery.
Patients: There were 376 women and 359 men, with a mean age of 51.1 years (
range, 12-77).
Intervention: Enlarged middle cranial fossa approach surgery.
Main Outcome Measures: Magnetic resonance imaging and computed tomography s
cans were used for follow-up and reevaluation of the operative sites. Facia
l nerve function and hearing were tested.
Results: Overall complete VS removal was achieved in 97.1% of patients. The
re were two recurrences (0.3 %) after microscopically complete tumor remova
l. Depending on the tumor size, postoperative normal and near-normal facial
outcome ranged from 83% to 99% (average, 92%), and hearing at or near the
preoperative level (+/- 15 dB pure-tone average or +/-: 15% speech discrimi
nation) was preserved in 60.2%, 48.2%, 23.9%, and 17.6%, respectively.
Conclusions: The EMFA is an excellent low-morbidity approach for VS removal
with limited cerebellopontine angle extension (2 cm). Specific advantages
of the EMFA are the superior internal auditory canal exposure, resulting in
an extremely low tumor recurrence rate; best capability for hearing preser
vation; and minimal incidence of cerebrospinal fluid leaks. Postoperative f
acial function outcome compares with that of other surgical approaches. The
best results are achieved in subjects with small tumors and good hearing,
advocating early diagnosis and treatment.