{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:29:49Z","timestamp":1792477789798,"version":"4.5.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Hearing preservation remains a challenging problem in vestibular schwannoma (VS) surgery. The ability to preserve hearing in patients with large tumors is subject to particular difficulty. In this study, the authors focus on hearing preservation in patients harboring large VSs.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 344 consecutive patients underwent surgical removal of VSs over the past 9 years. Of these 344 cases, 195 VSs were &gt; 20 mm in maximum cisternal diameter. Of the 195 cases, hearing preservation surgery was attempted for 54 patients who had a Class A, B, C, or D preoperative hearing level; that is, a pure tone average \u2264 60 dB and speech discrimination score \u2265 50% according to the Sanna\/Fukushima classification. The tumors were classified as moderately large (21\u201330 mm based on the largest extrameatal diameter), large (31\u201340 mm), and giant (\u2265 41 mm) according to the international criteria. The authors categorized patients with Class A, B, C, D, or E hearing (pure tone average \u2264 80 dB and speech discrimination score \u2265 40%) as having preserved hearing postoperatively.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Forty-one tumors (75.9%) were totally removed and 13 (24.1%) had near-total removal. Of the 54 patients, 29 maintained their hearing postoperatively; the overall hearing preservation rate was 53.7%. Analysis based on the preoperative hearing level showed that hearing was preserved in 14 (77.8%) of 18 cases for Class A; in 8 (47.1%) of 17 cases for Class B; in 4 (57.1%) of 7 cases for Class C; and in 3 (25.0%) of 12 cases for Class D. In addition, according to the analysis based on the tumor size, 20 (52.6%) of 38 patients with moderately large tumors retained their hearing, as did 5 (50.0%) of 10 patients with large tumors and 4 (66.7%) of 6 patients with giant tumors. Complications included 2 cases of bacterial meningitis that were cured by intravenous injection of antibiotics, 3 cases of subcutaneous CSF leakage that resolved without any surgical repair, and 1 case of temporary abducent nerve palsy. There were no deaths in this series.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results indicate that successful hearing preservation surgery in large VSs is possible with meticulous technique and attention to adhesions between the tumor and the cochlear nerves.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2008.12.jns08620","type":"journal-article","created":{"date-parts":[[2009,4,3]],"date-time":"2009-04-03T14:04:15Z","timestamp":1238767455000},"page":"845-854","source":"Crossref","is-referenced-by-count":50,"title":["Hearing preservation in surgery for large vestibular schwannomas"],"prefix":"10.3171","volume":"111","author":[{"given":"Masahiko","family":"Wanibuchi","sequence":"first","affiliation":[{"name":"Carolina Neuroscience Institute and"},{"name":"Carolina Ear Research Institute, Raleigh; and"},{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Carolina Neuroscience Institute and"},{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"McElveen","sequence":"additional","affiliation":[{"name":"Carolina Ear Research Institute, Raleigh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan H.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"Suppl","key":"b1-1110845","series-title":"J Neurosurg","first-page":"87","article-title":"Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 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