Preoperative Audiometry May Predict Hearing Improvement After Cerebellopontine Angle Meningioma Resection.

OBJECTIVE: Identify common characteristics in patients who had hearing improvement after cerebellopontine angle (CPA) meningioma resection. PATIENTS: Adult patients who underwent hearing-preservation-intent CPA meningioma resection. INTERVENTIONS: Data collected included patient, tumor, and surgical factors. Surgical approaches were retrosigmoid, combined petrosal, or anterior petrosectomy. MAIN OUTCOME MEASURES: Preoperative and postoperative word recognition scores (WRS), pure-tone average (PTA), and AAO-HNS hearing classification. RESULTS: Fifteen female patients (mean age: 52.5±14.4 y) underwent resection of CPA meningiomas (mean CPA dimension: 3.2±1.6 cm). Facial nerve function (House-Brackmann grade I or II) was preserved in all cases. Six of 10 (60%) of patients with serviceable preop hearing had hearing preserved, and 3 patients (20%) demonstrated improvement in AAO-HNS hearing class. These patients had preoperative WRS ranging from 0% to 32% and PTA from 32.5 to 42.5 dB. Tumors were inframeatal, retromeatal, or intracanalicular, with gross total resection in 2 cases. Median AAO-HNS hearing class improved from D to B, and mean WRS increased from 21.3% to 80.3% (P=0.01). Patients with hearing improvement had a worse mean preoperative WRS than patients without improvement (21.3% vs. 80%, P<0.01). No other single variable-including tumor CPA and IAC dimensions, location, surgical approach, extent of resection, age, or PTA-was predictive of hearing improvement. CONCLUSIONS: Hearing improvement was observed in a subset of CPA meningioma patients, particularly those with disproportionately poor WRS relative to PTA. These patients may benefit from a hearing-preservation surgical strategy.