Eur Arch Otorhinolaryngol (2009) 266:147–150 DOI 10.1007/s00405-008-0634-8 123 CASE REPORT Hearing preservation after translabyrinthine approach performed to remove a large vestibular schwannoma Stéphane Tringali · Chantal Ferber-Viart · Stéphane Gallégo · Christian Dubreuil Received: 29 June 2007 / Accepted: 25 February 2008 / Published online: 8 March 2008  Springer-Verlag 2008 Abstract We report the case of a 27-year-old woman from whom a left vestibular schwannoma (grade IV) was removed by a translabyrinthine approach. The initial period was uneventful except for a few days of vertigo. This patient had no facial paresis (House-Brackman grade I). She was seen 1, 3, 6 and 12 months after operation and reported a sensation of hearing in the left ear. The audiolog- ical studies showed a left medium hearing loss. At the 1- year follow-up visit, her hearing status was unchanged. A hearing aid was Wtted and functioned satisfactory. At the 5- year follow-up visit, audiometry studies were unchanged. Our case demonstrated that some hearing preservation could be obtained even if the vestibular schwannoma was large and excised by a translabyrinthine approach. Hearing with the help of a good hearing aid allowed a satisfactory function in this case. We believe that it is possible to pre- serve some hearing after translabyrinthine approach even if no care was taken to preserve the membraneous labyrinth and the loss of endolymph and even if the vestibular schwannoma was large. However, further experimental studies are needed to determine and understand the mecha- nisms of hearing preservation in this case. Keywords Hearing preservation · Translabyrinthine approach · Vestibular schwannoma Introduction There are essentially three approaches cure an acoustic schwannoma: the retrosigmoid, the middle crania fossa, and the translabyrinthine. Although hearing preservation is possible when the retrosigmoid and middle cranial fossa approaches are used, complete tumor removal is usually more diYcult [1] and facial paralysis more fre- quent than when a translabyrinthine approach is used [2]. The translabyrinthine approach provides a wide path for performing complete tumor removal with little risk to the facial nerve, but it induces deafness [2]. In 1991, McElv- een et al. [3] reported the Wrst case of an intracanalar acoustic schwannoma removed by a modiWed translaby- rinthine approach with some hearing preservation. In this translabyrinthine approach, the vestibule was not entered. In 2004, we reported [4] a new case of a patient who underwent operation with a modiWed translabyrinthine approach and who had useful preserved hearing that was stable after 21 months. Strangely, some authors reported hearing preservation after traditional translabyrinthine approach [5–7] for little vestibular schwannoma. We report the case of a 27-year-old woman from whom a large left vestibular schwannoma (stage IV) was removed by a traditional translabyrinthine approach. At 6 months after operation, she reported a sensation of hearing in the left ear. The audiological studies showed a left medium hearing loss. At the 1-year follow-up visit, her hearing S. Tringali (&) · S. Gallégo · C. Dubreuil Service d’Oto-neurochirurgie, Hospices Civils de Lyon, Centre hospitalier Lyon Sud, 69495 Pierre Benite Cedex, France e-mail: stephane.tringali@chu-lyon.fr C. Ferber-Viart Explorations Audiologiques et Orofaciales, Centre Hospitalier Lyon-Sud, 69310 Pierre Benite, France S. Tringali · C. Ferber-Viart UCB Lyon I UMR 5020 Neurosciences et systèmes sensoriels, IFR 19, Institut Fédératif des Neurosciences de Lyon, Lyon Cedex, France