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Simone A. Betchen, Jane Walsh, and Kalmon D. Post

S urgery for a VS is associated with a less than 1% rate of mortality and a greater than 95% rate of preserved facial function. 2, 7, 17 Rates of postoperative hearing preservation associated with VS surgery vary with the size of the tumor, the quality of the patient's preoperative hearing, and the skill of the surgeon, with reports ranging between 20 and 70% for patients with small tumors. 14, 17, 18, 23 There have been many studies in which hearing preservation rates immediately postoperatively have been evaluated, but only a few in which rates of long

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Masahiko Wanibuchi, Takanori Fukushima, John T. McElveen Jr., and Allan H. Friedman

T he surgeon attempting to remove a VS has a hierarchy of goals. These include complete tumor resection, with protection of the brainstem and blood vessels, and preservation of the facial nerve. After these goals are accomplished, the surgeon can attempt to preserve cochlear nerve function. In 1954, Elliott and McKissock 4 first reported successful hearing preservation in 2 of 3 patients who had VSs. Although the recent advances in microsurgical technique and instrumentation have brought substantial improvement, preservation of the cochlear nerve function

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Kalmon D. Post, Mark B. Eisenberg, and Peter J. Catalano

I n today's era of advanced microsurgical techniques and availability of facial nerve monitoring systems, total removal of vestibular schwannomas with preserved facial function can be routinely achieved except in the most difficult of cases. Having overcome many previous hurdles, attention has now been placed on the prediction and eventual preservation of “good” postoperative hearing. In the past it was difficult to analyze hearing preservation results because there was no agreement as to what constituted “hearing.” Some authors considered preservation of

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Jens Rachinger, Stefan Rampp, Julian Prell, Christian Scheller, Alex Alfieri, and Christian Strauss

the guidelines of the Committee on Hearing and Equilibrium for the evaluation of hearing preservation in acoustic neuroma of the AAO-HNS Foundation. 1 Preoperative hearing was categorized as Class A in 30 patients, Class B in 24, Class C in 12, and Class D with residual hearing remnants in 24 patients. A suboccipitolateral approach was used in all patients. Histological diagnosis was confirmed in all cases. Intraoperative monitoring was performed using continuous facial nerve electromyography, based on multiple-channel recordings (orbicularis oris, nasalis, and

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Mark E. Linskey

facilitating optimization of 3D planning conformality. 9 , 14 , 33 At the same time, the hearing preservation dose has been optimized without loss of confirmed tumor control over 10 years of follow-up imaging. 4 The number of patients who have undergone GKS SRS with long-term imaging follow-up at multiple centers has finally allowed statistical analysis and independent confirmation of many key variables related to hearing preservation for SRS ( Table 1 ). The time is now ripe to systematically review these factors. Current techniques yield hearing preservation rates > 74

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Hideyuki Kano, Douglas Kondziolka, Aftab Khan, John C. Flickinger, and L. Dade Lunsford

. We assessed hearing preservation with follow-up audiography, using the end points of preserving a specific GR hearing class (Class I–II) or serviceable hearing. Based on MR images of each radiosurgical plan, we defined the dose to the central cochlea (modiolus), at the vestibule, and in the middle of the horizontal semicircular canal, as well as the distance from the end of the tumor to the end of the IAC ( Figs. 1 – 4 ). Radiation doses at these points were derived using Leksell GammaPlan software. Statistical Analysis For statistical analysis we

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Joshua J. Wind, John P. Leonetti, Michael J. M. Raffin, Marc T. Pisansky, Brian Herr, Justin D. Triemstra, and Douglas E. Anderson

T he diagnosis and treatment of VSs (acoustic neuromas) have evolved significantly in the past several years and decades, with the natural history of the disorder and its surgical treatment currently elucidated. 17 , 19 , 23 , 38 Definitive microsurgical removal remains a viable therapeutic alternative for many patients. Continued efforts to refine microsurgical techniques have allowed improved facial nerve preservation, 1 , 17 , 26 , 28 , 29 , 37 and the authors of many retrospective studies have attempted to quantify the success of hearing preservation

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Takuzou Moriyama, Takanori Fukushima, Katsuyuki Asaoka, Pierre-Hugues Roche, David M. Barrs, and John T. McElveen Jr.

W ith advances in the surgical management of acoustic neuroma over the last three decades, total tumor removal can now be achieved in the majority of cases, with no deaths and a minimal incidence of morbidity. In addition, the advent of magnetic resonance imaging has potentially allowed the early detection of acoustic neuromas while they are small and are associated with good hearing. Attention has been increasingly focused on hearing preservation following total tumor removal. Hearing preservation in acoustic neuroma surgery can be accomplished using either

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Isaac Yang, Michael E. Sughrue, Seunggu J. Han, Derick Aranda, Lawrence H. Pitts, Steven W. Cheung, and Andrew T. Parsa

reported hearing preservation rates after GKS. 20 , 23 , 39 , 51 , 63 , 64 , 100 Our review of the literature on hearing preservation revealed impressive differences in outcomes for VS patients treated with GKS, with hearing preservation rates varying between 0 and 100% and with recent studies reporting a 50–70% range. 1 , 11 , 29 , 34–37 , 44 , 45 , 52 , 53 , 60 , 67 , 70 , 71 , 83 , 84 , 86 , 90 , 91 , 93 , 96 Several factors have been implicated in post-GKS hearing loss including the radiation dose, tumor volume, and patient age. In this study we performed an

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Anthony C. Wang, Steven B. Chinn, Khoi D. Than, H. Alexander Arts, Steven A. Telian, Hussam K. El-Kashlan, and B. Gregory Thompson

VS was observed in 64% of cases in the 1st year, in an additional 23% by the 2nd year, and in 5% more by the 3rd year. The widespread use of MRI has resulted in earlier diagnosis of VS, such that patients with very small lesions and excellent residual hearing in the involved ear often present for treatment consideration. Hearing preservation is a reasonable primary goal of management in such cases. Techniques and technologies used in the operative management of VS have progressively improved with the advancement of microsurgical techniques. Mortality and major