Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas

Carlson, Matthew L.; Vivas, Esther; McCracken, David J.; Sweeney, Alex D.; Neff, Brian A.; Shepard, Neil T.; Olson, Jeffrey J.

doi:10.1093/neuros/nyx511

Cited by 100 publications

(94 citation statements)

References 92 publications

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“…In a recent systematic review, the Congress of Neurological Surgeons concluded that cochlear doses 4 Gy, marginal tumor doses 12 Gy, smaller tumor size, and "good preoperative word recognition and/or pure tone thresholds" are the "most consistent prognostic features associated with maintenance of serviceable hearing." 37 It is interesting to note that radiation to non-VS cerebellopontine angle tumors has been found to have different hearing preservation rates when compared with VS patients, despite cochlear doses exceeding 7 to 10 Gy. 25 For example, Hasegawa and colleagues reported on 42 patients with facial nerve schwannomas treated with SRS, 20 of whom had PTA 50 dB before treatment.…”

Section: Tumor Characteristics and Locationmentioning

confidence: 99%

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Tolisano

Hunter

2019

J Neurol Surg B

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Despite no universally accepted definition of hearing preservation following vestibular schwannoma (VS) treatment, numerous variables have been identified as possible factors that may affect hearing outcomes following radiotherapy. Age, pretreatment hearing, radiation dose, tumor location and size, length of follow-up, fractionation, and timing of radiation have all been explored, among other variables, as factors related to hearing outcomes following radiation. These variables and associated hearing outcomes will be explored in detail, summarizing the literature to date to improve patient counseling for those patients who present with serviceable hearing and are considering their VS management options.

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Section: Tumor Characteristics and Locationmentioning

confidence: 99%

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Tolisano

Hunter

2019

J Neurol Surg B

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“…Long-term follow-up comparisons between SRS and surgery are still lacking. Nevertheless, for smaller tumors SRS is the preferred treatment strategy in most skull base centers [109].…”

Section: Primary Radiotherapy In Small To Medium Vsmentioning

confidence: 99%

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

Yao

Alahmari

Temel

et al. 2020

Cancers

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Vestibular schwannoma (VS) is a benign primary brain tumor that occurs sporadic or as part of a genetic syndrome. The most common cause is the mutation of the NF2 tumor suppressor gene that is involved in the production of the protein merlin. Merlin plays a role in cell growth and cell adhesion. In patients with NF2, the VSs arise bilaterally and coincide with other brain tumors. In sporadic VS, the tumor is typically unilateral and does not coincide in combination with other tumors. MRI is the standard imaging technique and can be used to assess the size and aspect of the tumor as well as the progression of disease. The preferred management of large VS in both VS types is surgery with or without adjuvant radiation. The management for the medium- or small-sized VS includes wait and scan, radiotherapy and/or surgery. This choice depends on the preference of the patient and institutional protocols. The outcomes of surgical and radiotherapy treatments are improving due to progress in surgical equipment/approaches, advances in radiation delivery techniques and dose optimizations protocols. The main purpose of the management of VS is preserving function as long as possible in combination with tumor control.

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“…There is a consensus for large VS to be managed surgically with either total, near‐total, or subtotal ablation to preserve normal facial nerve function on the one hand and to avoid life‐threatening sequelae on the other. For small‐ and medium‐sized VS, the decision‐making process between surveillance, radiosurgery, and microsurgery is not well defined . Many factors, whose influence differs from one center to another, are taken into account including VS volume and its growth tendency, hearing level, associated symptoms such as dizziness and facial numbness, age, and comorbidities as well as patient willingness.…”

Section: Introductionmentioning

confidence: 99%

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing

et al. 2019

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Objectives/Hypothesis: To outline a possible decision-making process for sporadic vestibular schwannoma (VS) with contralateral nonserviceable hearing at diagnosis.Study Design: Retrospective case series. Methods: Diagnosed VS was studied in a tertiary referral center from 1995 to 2013. Results: Twenty-eight patients were included, with a mean follow-up of 6.9 years (range = 0.5-20 years). Ten were stage 1, 10 were stage 2, five were stage 3, and three were stage 4. Ipsilateral hearing levels were A (n = 3), B (n = 10), C (n = 7) and D (n = 8) American Academy of Otolaryngology-Head and Neck Surgery classification. Contralateral hearing levels were C (n = 11) and D (n = 17). Initial VS management included surveillance (n = 12) or surgery (n = 16), and four patients were later treated with surgery (n = 3) or stereotactic irradiation (n = 1). Hearing was improved by hearing aids and/or etiological treatment (n = 8), restored by contralateral (n = 15) or ipsilateral (n = 4) cochlear implants (CIs), or ipsilateral auditory brainstem implants (ABIs) (n = 3). Finally, 18 CIs were active daily; 14 of them presented high or moderate benefit with mean open-set dissyllabic word scores (WRS) of 58.1% and sentence recognition scores (SRS) of 69.7%, but only one ABI was still active (WRS of 70% and SRS of 87% with lip reading).Conclusions: When early removal of VS was not necessary, contralateral CI or etiological treatment for hearing loss might be recommended initially. Ipsilateral CI is proposed, whereas VS should be operated on if previous hearing restoration was not successful. ABI should be reserved for the rare cases where a contralateral CI could not be implanted or the cochlear nerve was sectioned during VS removal.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas

Cited by 100 publications

References 92 publications

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing

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