Can You Hear Me Now? Long-Term Hearing Preservation in Intracanalicular Vestibular Schwannoma

OBJECTIVE In the era of MRI, vestibular schwannomas are often recognized when patients still have excellent hearing. Besides success in tumor control rate, hearing preservation is a main goal in any procedure for management of this population. The authors evaluated whether modified auditory subclassification prior to radiosurgery could predict long-term hearing outcome in this population. METHODS The authors reviewed a quality assessment registry that included the records of 1134 vestibular schwannoma patients who had undergone stereotactic radiosurgery during a 15-year period (1997–2011). The authors identified 166 patients who had Gardner-Robertson Class I hearing prior to stereotactic radiosurgery. Fifty-three patients were classified as having Class I-A (no subjective hearing loss) and 113 patients as Class I-B (subjective hearing loss). Class I-B patients were further stratified into Class I-B1 (pure tone average ≤ 10 dB in comparison with the contralateral ear; 56 patients), and I-B2 (> 10 dB compared with the normal ear; 57 patients). At a median follow-up of 65 months, the authors evaluated patients' hearing outcomes and tumor control. RESULTS The median pure tone average elevations after stereotactic radiosurgery were 5 dB, 13.5 dB, and 28 dB in Classes I-A, I-B1, and I-B2, respectively. The median declines in speech discrimination scores after stereotactic radiosurgery were 0% for Class I-A (p = 0.33), 8% for Class I-B1 (p < 0.0001), and 40% for Class I-B2 (p < 0.0001). Serviceable hearing preservation rates were 98%, 73%, and 33% for Classes I-A, I-B1, and I-B2, respectively. Gardner-Robertson Class I hearing was preserved in 87%, 43%, and 5% of patients in Classes I-A, I-B1, and I-B2, respectively. CONCLUSIONS Long-term hearing preservation was significantly better if radiosurgery was performed prior to subjective hearing loss. In patients with subjective hearing loss, the difference in pure tone average between the affected ear and the unaffected ear was an important factor in long-term hearing preservation.

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Usefull Hearing Preservation Is Improved in Vestibular Schwannoma Patients Who Undergo Stereotactic Radiosurgery Before Further Hearing Deterioration Ensures

10.21203/rs.3.rs-180869/v1 ◽

2021 ◽

Author(s):

Hideyuki Kano ◽

Akiyoshi Ogino ◽

Hao Long ◽

Stephen Johnson ◽

Andrew Faramand ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Hearing Preservation ◽

Initial Diagnosis ◽

Speech Discrimination ◽

Pure Tone Average ◽

Younger Age ◽

Grade Ii ◽

Preservation Rate

Abstract IntroductionThe present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.MethodsWe retrospectively analyzed 1447 VS patients who underwent SRS between 1992 to 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.ResultsThe serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (<55 years, p=0.012) and HM during observation (p<0.001) improved serviceable hearing preservation rates. Patients whose PTA increased >15 dB (p=0.011) or whose SDS declined >10% (p=0.024) had reduced serviceable hearing preservation rates.ConclusionsHearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.

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GAMMA KNIFE RADIOSURGERY IN YOUNGER PATIENTS WITH VESTIBULAR SCHWANNOMAS

Neurosurgery ◽

10.1227/01.neu.0000345944.14065.35 ◽

2009 ◽

Vol 65 (2) ◽

pp. 294-301 ◽

Cited By ~ 61

Author(s):

Javier Lobato-Polo ◽

Douglas Kondziolka ◽

Oscar Zorro ◽

Hideyuki Kano ◽

John C. Flickinger ◽

...

Keyword(s):

Gamma Knife ◽

Vestibular Schwannoma ◽

Gamma Knife Radiosurgery ◽

Hearing Preservation ◽

Vestibular Schwannomas ◽

Surgical Removal ◽

Management Options ◽

Younger Patients ◽

Cranial Nerve Dysfunction

Abstract OBJECTIVE Management options for patients with vestibular schwannoma include observation, surgical resection, stereotactic radiosurgery (SRS), and stereotactic radiation therapy. In younger patients, resection is often advocated because of concern regarding the long-term effects of radiation. We studied tumor response and clinical outcomes after SRS in such patients. METHODS We reviewed long-term outcomes in 55 patients with vestibular schwannomas. Patients were 40 years of age or younger, underwent gamma knife (GK) SRS between 1987 and 2003, and were followed up for a minimum of 4 years. The median patient age was 35 years (range, 13–40 years). Forty-one patients had Gardner-Robertson class 1 to 4 hearing. Thirteen patients (24%) had undergone surgical removal. The median tumor volume was 1.7 mm3. The median tumor margin dose was 13.0 Gy (range, 11–20 Gy). RESULTS At a median of 5.3 years, (range, 4–20 years), 2 of 55 patients underwent GK SRS for a second time; 1 of these patients had had a recurrence after initial resection. The 5-year rate of freedom from additional management was 96%. Hearing preservation rates (i.e., remaining within the same Gardner-Robertson hearing class) were 93%, 87%, and 87% at 3, 5, and 10 years, respectively. In patients with serviceable hearing before SRS, it was maintained in 100%, 93%, and 93% of patients at 3, 5, and 10 years, respectively. Hearing preservation was related to a margin dose lower than 13 Gy (P = 0.017). At the last assessment, facial and trigeminal nerve function was preserved in 98.2% and 96.4% of patients, respectively; the only facial deficit (House-Brackmann grade III) occurred in a patient who received a tumor dose of 20 Gy early in our experience (1988). None of the patients treated with doses lower than 13 Gy experienced facial or trigeminal neuropathy. All patients continued their previous level of activity or employment after GK SRS. No patient developed a secondary radiation-related tumor. CONCLUSION Our experience indicates that GK SRS is an effective management strategy for younger patients with vestibular schwannoma, most of whom have no additional cranial nerve dysfunction.

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Long-Term Hearing Preservation After Microsurgical Excision of Vestibular Schwannoma

Otology & Neurotology ◽

10.1097/mao.0b013e3181edb8b2 ◽

2010 ◽

Vol 31 (7) ◽

pp. 1144-1152 ◽

Cited By ~ 46

Author(s):

Erika Ann Woodson ◽

Ryan Douglas Dempewolf ◽

Samuel Paul Gubbels ◽

Aaron Thomas Porter ◽

Jacob Jay Oleson ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Hearing Preservation

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Retrolabyrinthine Meatotomy as Part of Retrosigmoid Approach to Expose the Whole Internal Auditory Canal: Rationale, Technique, and Outcome in Hearing Preservation Surgery for Vestibular Schwannoma

Operative Neurosurgery ◽

10.1093/ons/opx091 ◽

2017 ◽

Vol 14 (1) ◽

pp. 36-44 ◽

Cited By ~ 12

Author(s):

Antonio Mazzoni ◽

Elisabetta Zanoletti ◽

Luca Denaro ◽

Alessandro Martini ◽

Domenico d’ Avella

Keyword(s):

Vestibular Schwannoma ◽

Internal Auditory Canal ◽

Residual Tumor ◽

Hearing Preservation ◽

Retrosigmoid Approach ◽

Long Term Results ◽

Consecutive Series ◽

Unfavorable Condition ◽

Hearing Preservation Surgery

Abstract BACKGROUND Vestibular schwannoma extending to the fundus of the internal auditory canal is currently considered an unfavorable condition for hearing preservation surgery via a retrosigmoid approach because the lateral end of the canal is hard to view directly during microsurgery. OBJECTIVE To present an improved retrolabyrinthine meatotomy (RLM) technique that enables the full length of the cochlear and facial nerves to be inspected up to their orifices on the fundus. Long-term results are briefly reported. METHODS A consecutive series of 100 cases with various degrees of fundus involvement underwent surgery via a retrosigmoid approach and RLM. The follow-up ranged from 4 to 14 yr. Outcomes on hearing and facial nerve function were recorded, and preoperative MRI findings of the tumor on the fundus were correlated with the surgical findings and the long-term radicality of the tumor resection. RESULTS Residual tumor on the fundus was identified in 3 cases, all belonging to the group with tumors adhering to the fundus. The functional results were in line with the best reported outcomes of this surgery. CONCLUSION RLM via a retrosigmoid approach seemed adequate for the purposes of hearing preservation surgery and enabled the full course of the facial and cochlear nerves through the internal auditory canal to be exposed to direct view. Tumors adhering to the vestibular quadrant of the fundus were more difficult to remove, and there were a few cases of local residual tumor.

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Long-Term Hearing Preservation After Surgery for Vestibular Schwannoma

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(08)70372-7 ◽

2006 ◽

Vol 2006 ◽

pp. 207-209

Author(s):

A.H. Kaye

Keyword(s):

Vestibular Schwannoma ◽

Hearing Preservation

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The Effect of Prescription Isodose Variation on Tumor Control and Toxicities in Stereotactic Radiosurgery for Sporadic Vestibular Schwannoma: Propensity Score-Matched Case–Control Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718908 ◽

2021 ◽

Author(s):

Achiraya Teyateeti ◽

Christopher S. Graffeo ◽

Avital Perry ◽

Eric J. Tryggestad ◽

Paul D. Brown ◽

...

Keyword(s):

Propensity Score ◽

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Hearing Preservation ◽

Tumor Control ◽

Gamma Knife Stereotactic Radiosurgery ◽

The Impact ◽

Prescription Isodose

Abstract Objective Vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (SRS) was typically performed at 50% isodose line (IDL50); however, the impact of IDL variation on outcomes is poorly understood. This study aimed to compare tumor control (TC) and toxicities between treatment at 40% (IDL40) and 50% (IDL50). Methods and Materials Sporadic/unilateral VS patients treated with SRS dose 12 to 14 Gy and prescription isodose volume ≤10cm3 were included. Propensity score matching was applied to IDL40 cohort to generate an IDL50 companion cohort, adjusting for age and prescription isodose volume. After exclusion of patients with follow-up <24 months, there were 30 and 28 patients in IDL40 and IDL50 cohorts, respectively. Results Median follow-up time was 96 months (24–225 months). Actuarial and radiographic TC rates were 91.8% and clinical TC was 96.2% both at 5 and 10 years. TC was higher in IDL40 cohort but not significant (96.4 vs. 86.7%; p = 0.243). Hearing preservation (HP) rates were 71.9 and 39.2% at 5- and 10-year intervals, with significantly higher rates of HP noted in IDL40 cohort (83.3 vs. 57.1% at 5-year interval; 62.5 vs. 11.4% at 10-year interval; p = 0.017). Permanent facial neuropathy occurred in two patients, both from the IDL50 cohort (3.5%). Rates of post-SRS steroid treatment or shunt placement for hydrocephalus were slightly higher in IDL50 patients (6.9 vs. 17.9%; p = 0.208 and 3.3 vs. 7.1%; p = 0.532). Conclusion For treatment of VS with SRS, dose prescription at IDL40 or IDL50 provides excellent long-term TC and toxicity profiles. IDL40 may be associated with improved long-term HP.

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