OBJECTIVE: To determine whether cervical vestibular evoked myogenic potentials 
(cVEMPs) are predictive of hearing preservation in patients undergoing 
vestibular schwannoma removal through middle fossa craniotomy approach.
STUDY DESIGN: Retrospective case study.
SETTING: Tertiary referral center.
PATIENTS: Eighteen patients who underwent a middle fossa craniotomy for 
vestibular schwannoma (stage I or II of Koos classification) with attempted 
hearing preservation from January 2008 to February 2016 were retrospectively 
reviewed.
INTERVENTION: Pre-surgical cVEMPs test, videonystagmography (caloric test), and 
magnetic resonance imaging (MRI) as well as a pre- and post-surgical audiometry 
test.
MAIN OUTCOME MEASURES: cVEMPs parameters including amplitude asymmetry ratio 
(AR), P13, and N23 latencies and peak-to-peak amplitude between P13 and N23 
waves were calculated. Hearing data were classified according to the AAO-HNS 
hearing classes. The nerve of origin of the tumor was specified during surgery 
and the largest tumor diameter was measure on MRI axial plane on T2-CISS weighed 
images.
RESULTS: Preoperative amplitude asymmetry ratio was lower (n = 15, Mann-Whitney 
U test, p < 0.001) in the group with postoperative hearing preservation (n = 11) 
compared with the group with postoperative hearing preservation failure (n = 4). 
The positive predictive value of an AR less than 24% to assess postoperative 
hearing preservation is 91.6%. Tumor size and localization were not correlated 
with cVEMPs, nor with caloric testing in this group of small-sized 
intracanalicular vestibular schwannomas.
CONCLUSIONS: Our data suggest that cVEMPs may help predict hearing preservation 
outcome in vestibular schwannoma surgery via the middle fossa craniotomy 
approach.