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Neurosurgery. 2018 Sep 20. doi: 10.1093/neuros/nyy407. [Epub ahead of print]

Long-Term Hearing Outcomes Following Stereotactic Radiosurgery in Vestibular Schwannoma Patients-A Retrospective Cohort Study.

Author information

1
Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, California.
2
Department of Ear Sciences, The University of Western Australia, Nedlands, Australia.
3
Ear Science Institute Australia, Subiaco, Australia.
4
Department of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, Utah.
5
Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
6
Department of Radiation Oncology, Stanford University, Palo Alto, California.
7
School of Population and Global Health, The University of Western Australia, Nedlands, Australia.
8
Department of Neurosurgery, Stanford University, Stanford, California.

Abstract

BACKGROUND:

An understanding of the hearing outcomes is needed for treatment counseling for patients with vestibular schwannomas (VS).

OBJECTIVE:

To determine long-term hearing results following stereotactic radiosurgery (SRS) for VS and identify any influential variables.

METHODS:

Tertiary hospital retrospective cohort.

RESULTS:

There were 579 tumors (576 patients) treated with SRS. Eighty-two percent (473) of tumors had ≥1 yr and 59% (344 ≥3 yr follow-up. In the 244 tumor ears, with measurable hearing before SRS who were followed ≥1 yr, 14% (31) had improved hearing, 13% (29) unchanged hearing, and 74% (158) had worsened hearing. In 175 patients with ≥3 yr follow-up and who had measurable hearing pretreatment, 6% (11 ears) improved hearing, 31% (54 ears) unchanged hearing, and 63% (110 ears) had worsened hearing. Patients with tumors with larger target volumes (P = 0.040) and with neurofibromatosis type 2 (NF2; P = 0.017) were associated with poorer hearing (P = 0.040). Patients with word recognition scores (WRS) of 50% or poorer had tumors with a larger volume (P = 0.0002), larger linear size (P = 0.032), and NF2 (P = 0.045). Traditionally reported hearing outcomes using the Gardner Robertson maintenance of PTA ≤50 db or WRS ≥50% were 48% at 3 yr, which overestimates hearing outcomes compared to the above reporting standards.

CONCLUSION:

Hearing declines over time in VS treated with SRS in a high proportion of cases. The frequency and magnitude of long-term hearing decline following SRS argues against prophylactic radiation for small tumors in hearing ears with undetermined growth behavior.

PMID:
30247723
DOI:
10.1093/neuros/nyy407

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