Acoustic neuroma surgery: the results of hearing conservation surgery.

Between the years of 1978 and 1986 attempts have been made to save the hearing in 47 patients with unilateral pathologically confirmed acoustic neuromas. The middle fossa approach has been used in 32 cases and the suboccipital approach in 15 cases. Our review demonstrates an advantage using the suboccipital approach to excise most of these tumors. The success rate is higher (47% vs. 31%) and complications fewer using the suboccipital route. Despite these findings the middle fossa approach may be preferable in selected tumors located laterally in the internal auditory canal. In an effort to better select patients for hearing conservation surgery, an analysis of preoperative data (demographics, audiometry, evoked auditory response testing, and tumor size) was performed. Although certain guidelines have evolved to more accurately select hearing conservation surgery candidates, we are still unable to do so reliably. Preoperative auditory brain stem response testing, however, may evolve as a useful indicator for a successful hearing operation. The findings of our preoperative data analysis, surgical results, and complications are reviewed.