Conservation of hearing in acoustic neurilemmoma excision.

Conservation of hearing in acoustic neurilemmoma surgery is possible by the suboccipital route. The hearing preservation prognosis decreases as the size of the cerebellopontine angle neoplasm increases. Von Recklinghausen disease spells a poor prognosis for hearing. Some hearing was retained in seven of ten patients with preoperative hearing. Three patients retained postoperative hearing levels and speech sound discrimination equal to preoperative levels. One patient had a progressive high-frequency sensorineural hearing loss in the nontumor ear and was fitted with a hearing aid for the postoperative ear; he now has successful binaural hearing function. Gentle technique, microhemostasis, special instrumentation, and well-developed surgical craft are essential for preserving the microstructures necessary for hearing. Furthermore, the suboccipital approach for neurilemmomas less than 2 cm gives good surgical exposure and a reasonable chance to save hearing.