Stability of Hearing Function After Middle Fossa Craniotomy for Sporadic Vestibular Schwannoma

Objective: To evaluate the long-term stability of hearing function after middle fossa craniotomy (MFC) for sporadic vestibular schwannoma (VS), and to characterize which patients maintain serviceable hearing over years of follow-up. Methods: We retrospectively reviewed prospectively collected data in 129 consecutive patients undergoing MFC for sporadic VS at a single institution. To be included, patients were required to have at least two of three postoperative audiometric assessments: immediate postoperative, 1-year, or late (≥2 years). Audiometric outcomes were classified by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) hearing classes. Serviceable hearing was defined as class A or B. Median timing of follow-up evaluations was 12.0 months (IQR 10.0–14.0) for the 1-year time point and 33.0 months (IQR 20.0–48.5) for the late time point. The “last” time point was defined as the latest available audiogram for each patient, which could represent either the 1-year or late evaluation depending on clinical follow-up. Stability of hearing preservation was assessed by stratifying patients by their initial postoperative hearing class and tracking class transitions at subsequent time points. Statistical analysis was done in R in R (ver. 4.5.1). Results: The cohort included 71 women (55%) and 58 men (45%), with a mean age of 51.4 years (SD 10.4). Median tumor size was 10 mm [IQR 8–12]. Most patients (92.2%) presented with serviceable hearing (AAO-HNS A/B). Immediately postoperatively, serviceable hearing was preserved in 72% of patients (33.3% class A, 38.8% class B of whole cohort). Patients with serviceable hearing immediately postop ( n = 93) had durable function ( Table 1 ). At 1 year, 89.8% of these remained serviceable (42.0% A, 47.8% B); at late follow-up, 76.0% were serviceable (21.7% A, 54.3% B). Overall, 85% of patients with early post-operative serviceable hearing maintained that function by last follow up ([ Fig. 1 ]). Similarly, patients with non-serviceable hearing immediately postop ( n = 36) also had durable dysfunction, though some improvement was surprisingly seen in select cases. Overall, at last follow-up 16.7% (5/36) of patients with initially non-serviceable hearing had now class A/B hearing. In sum, functional recovery, though possible, was rare, and most patients with non-functional hearing after surgery remained so at last follow-up. Conclusion: This large single-institution series of MFC for sporadic VS, demonstrates that hearing preserved immediately after surgery is generally durable across years of follow-up in accordance with the literature in smaller cohorts. Patients with class A or B hearing postoperatively overwhelmingly maintained serviceable hearing, while those with early nonfunctional hearing rarely regained it. Defining “last follow-up” as the latest available audiogram (1-year or late) reflects real-world variability in surveillance, but still shows sustained preservation. These results suggest that MFC not only achieves immediate hearing preservation but also offers long-term durability superior to observation or radiosurgery, where progressive decline is typical. Table 1 [ Fig. 1 ] Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany