Long-Term Vestibular Outcomes Following Resection of Cerebellopontine Angle Meningiomas: A 36-Month Longitudinal Retrospective Study

The objective of this study is to evaluate vestibular recovery over 36 months following cerebellopontine angle (CPA) meningioma resection and identify clinical and surgical predictors of symptom resolution. This is a retrospective study. Single academic tertiary care medical center. Forty-two patients with CPA meningiomas and preoperative cranial nerve VIII involvement who either presented with vestibular dysfunction or developed new vestibular deficits postoperatively. Vestibular function assessed at baseline and 1, 6, 12, 24, and 36 months, coded as symptomatic or asymptomatic. Logistic regression and Cox proportional hazards modeling controlled for age, sex, tumor volume, presenting symptoms, surgical approach, and extent of resection. Kaplan–Meier analysis compared recovery timing across subgroups. Median age was 54.5 years; median tumor volume was 8.9 cm3. Most tumors were resected via a retrosigmoid approach (83.3%), with gross total resection achieved in 66.7%. Vestibular deficits were present in 92.9% preoperatively and declined to 57.9% in the first postoperative month (p < 0.001). At 36 months, 27.3% remained symptomatic. No consistent predictors of resolution were identified. Recovery was delayed in patients with both hearing and vestibular symptoms compared to those with vestibular-only dysfunction (21.5 vs. 10.5 months; p = 0.047). Among patients with CPA meningiomas and preoperative cranial nerve VIII involvement, most experienced recovery of vestibular function following resection, with improvements continuing through 3 years postoperatively. Recovery was slower in those presenting with both hearing and vestibular symptoms, whereas traditional surgical and anatomical variables were not predictive. These findings may inform patient counseling and guide recovery expectations.