Prophylactic Nimodipine for Hearing Preservation in Vestibular Schwannoma: A Retrospective Cohort Study.

Abstract

Background: Vestibular schwannoma surgery poses a significant challenge for hearing and facial function preservation. Prophylactic nimodipine has been studied as a pharmacologic strategy to protect cranial nerve function after hearing preservation surgery, but it has not been thoroughly evaluated. This study aimed to assess the role of prophylactic nimodipine in promoting hearing and facial function following vestibular schwannoma surgery and to evaluate the dose-response relationship between nimodipine administration and patient outcomes.

Methods: We conducted a retrospective analysis on a cohort of vestibular schwannoma patients who underwent hearing preservation surgery at a tertiary care hospital between November 2017 and December 2024. Hearing outcomes were assessed using word recognition scores and pure tone audiometry, and facial function outcomes were assessed with House-Brackmann Score. Regression analyses were performed to determine the impact of nimodipine on hearing preservation and to evaluate dose-response relationships.

Results: The study included 58 control patients and 340 nimodipine-treated patients. Nimodipine treatment significantly improved cranial nerve outcomes. Compared to controls, nimodipine-treated patients had 2.0 times greater odds of preserving word recognition score (OR: 1.92, 95% CI: 1.08-3.44, P = .027), 1.5 times greater odds of preserving pure tone average (OR: 1.49, 95% CI: 0.84-2.66, P = .17), and 2.0 times greater odds of preserving facial nerve function (OR: 2.02, 95% CI: 1.10-3.73, P = .024). Dose-response analyses revealed that each additional nimodipine dose was associated with a 2.3% improvement in word recognition (P < .001), 1.7% improvement in pure tone average preservation (P < .001), and 1.1% improvement in facial nerve preservation (P = .049).

Conclusion: Prophylactic nimodipine demonstrates potential efficacy in enhancing post-operative cranial nerve function after hearing preservation vestibular schwannoma surgery. These findings support further investigation through prospective studies to confirm nimodipine's clinical utility.