Management of vestibular schwannomas (acoustic neuromas): The value of neurophysiology for evaluation and prediction of auditory function in 420 cases

OBJECTIVE: From 1978 to 1993, 1000 vestibular schwannomas were operated on at the Department of Neurosurgery at Nordstadt Hospital. The goal was to improve the chances of hearing preservation by recording auditory brain stem responses (ABRs). ABRs can be used for preoperative classification of cochlear nerve impairment and for prediction of the chances of hearing preservation. PATIENTS AND METHODS: In addition to the previously described audiometric testing, the patients underwent perioperative and intraoperative bilateral ABR recording at 100-dB condensation and rarefaction click stimulation. The classification system of five types of ABRs, as presented before, is based on the presence and on the latencies of Waves I, III, and V, with a special emphasis on Wave III's representing the activity of the first brain stem nuclei within the auditory pathway. According to an analysis of 420 preoperative ABRs, in case of a preoperative Type 1 or 2, the rate of hearing preservation is 80%. DISCUSSION: In the case of good clinical and audiometric hearing, a severely deteriorated ABR is mostly an indicator of severe nerve compression and adhesion by the tumor. In view of subsequently reported experiences with intraoperative ABR monitoring, the value of the presented system emphasizing the importance of Wave III is stressed and discussed with other views in the literature. The criteria presented here are not designed for recognition of retrocochlear disease but aim for evaluation of the state of the auditory nerve and its perspective. CONCLUSION: By the presented classification of ABR Types B1 through B5, preoperative prediction of the likelihood of hearing preservation is improved.