Preservation of Facial Nerve Function and Serviceable Hearing After Surgical Resection of Vestibular Schwannomas

Introduction: Hearing preservation and facial nerve function are critical considerations in surgical management of vestibular schwannomas. Identifying factors associated with successful outcomes can guide patient counseling and improve prognostication. We analyzed clinical and radiographic variables that may serve as predictors of hearing preservation and postoperative facial nerve function.

Methods: A retrospective review of 75 patients with vestibular schwannomas undergoing surgical resection was conducted. Patient demographics, preoperative hearing status (PTA and WRS), tumor characteristics (Koos grade, radiographic parameters), and postoperative outcomes were collected. Outcomes were assessed for hearing preservation (AAO-HNS Class A or B) and facial nerve function using House-Brackmann (HB) grading.

Results: The cohort had a mean age of 47.4 ± 11.9 years, with 57.3% female. Preoperatively, 64% were classified as AAO-HNS Hearing Class A, with a mean PTA of 25.8 dB and median WRS of 96%. Postoperatively, 29.3% achieved serviceable hearing preservation (Class A or B). Significant predictors of hearing preservation included younger age (mean 41.6 vs. 49.8 years), lower Koos grade (72.7% in Koos 1-2 vs. 27.3% in Koos 3-4), and a shorter tumor length (mean 12.7 +/- 8.2 mm). There was a 77.3% gross total resection rate with a post-operative HB 1 appreciated in 74.7% of patients.

Conclusion : Younger patients, lower Koos grade, and smaller tumors are more likely to achieve post-operative hearing preservation (AAO-HNS Class A or B). The high rate of favorable facial nerve outcomes (HB 1 or 2) highlights effective surgical management in this patient cohort. Identifying factors that predict postoperative hearing and facial nerve functional preservation can support pre-operative decision making and facilitate prognostication.