{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:34:21Z","timestamp":1777422861110,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The diagnosis of large vestibular schwannomas (VS) with retained useful hearing has become increasingly common. Preservation of facial nerve (FN) function has improved using intraoperative EMG monitoring, hearing preservation remains challenging, with the recent use of cochlear nerve action potential (CNAP) monitoring. This prospective longitudinal series of VS with useful hearing operated on using a retrosigmoid approach included 37 patients with a mean largest extrameatal VS. diameter of 25 \u00b1 8.7 mm (81% of Koos stage 4). CNAP was detected in 51% of patients, while auditory brainstem responses (ABR) were present in 22%. Patients were divided into two groups based on the initial intraoperative CNAP status, whether it was present or absent. FN function was preserved (grade I\u2013II) in 95% of cases at 6 months. Serviceable hearing (class A + B) was preserved in 16% of the cases, while 27% retained hearing with intelligibility (class A\u2013C). Hearing with intelligibility (class A\u2013C) was preserved in 42% of cases when CNAP could be monitored in the early stages of VS resection versus 11% when it was initially absent. Changes in both the approach to the cochlear nerve and VS resection are mandatory in preserving CNAP and improve the rate of hearing preservation.<\/jats:p>","DOI":"10.3390\/jcm12216906","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T09:28:13Z","timestamp":1698917293000},"page":"6906","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Monitoring Cochlear Nerve Action Potential for Hearing Preservation in Medium\/Large Vestibular Schwannoma Surgery: Tips and Pitfalls"],"prefix":"10.3390","volume":"12","author":[{"given":"Baptiste","family":"Hochet","sequence":"first","affiliation":[{"name":"D\u00e9partement d\u2019Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7826-0721","authenticated-orcid":false,"given":"Hannah","family":"Daoudi","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"},{"name":"Technologies and Gene Therapy for Deafness, Institut de l\u2019Audition\/Institut Pasteur, 75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"Lefevre","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yann","family":"Nguyen","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"},{"name":"Technologies and Gene Therapy for Deafness, Institut de l\u2019Audition\/Institut Pasteur, 75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Bernat","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurophysiologie, Groupe Hospitalier Piti\u00e9-Salp\u00e9tri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Sterkers","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"},{"name":"Technologies and Gene Therapy for Deafness, Institut de l\u2019Audition\/Institut Pasteur, 75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1067-045X","authenticated-orcid":false,"given":"Ghizlene","family":"Lahlou","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Oto-Rhino-Laryngologie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"},{"name":"Technologies and Gene Therapy for Deafness, Institut de l\u2019Audition\/Institut Pasteur, 75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Kalamarides","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie, Groupe Hospitalo-Universitaire Piti\u00e9-Salp\u00eatri\u00e8re, APHP, Sorbonne Universit\u00e9, 75013 Paris, France"},{"name":"CRICM INSERM U1127 CNRS UMR 7225, Paris Brain Institute, Genetics and Development of Brain Tumors, 75013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"ref_1","first-page":"388","article-title":"Long-Term Outcome after Gamma Knife Radiosurgery for Acoustic Neuroma of All Koos Grades: A Single-Center Study","volume":"132","author":"Frischer","year":"2018","journal-title":"J. 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