Hearing Preservation After Intervention in Vestibular Schwannoma

Abstract

ObjectiveThis study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.Study DesignRetrospective review.SettingTertiary academic center.PatientsAdults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.InterventionsGamma Knife, middle cranial fossa, or retrosigmoid approaches.Main Outcome MeasuresPure-tone audiometry and speech discrimination scores.ResultsPostintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0–15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67–2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24–35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06–0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively (p = 0.75).ConclusionsAfter vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.

The Outcome of the Retrosigmoid approach in the Vestibular Schwannomas decompression, A Retrospective Cohort Study of 60 consecutive cases

“…Other authors found that serviceable hearing (Class A/B) was preserved in 70.4% of patients [15 ]. Unfortunately, this preservation of acoustic function could deteriorate with time [16,17].In our group of patients, 55 (91%)…”

CyberKnife Stereotactic Radiosurgery for Growing Vestibular Schwannoma: Longitudinal Tumor Control, Hearing Outcomes, and Predicting Post‐Treatment Hearing Status

“…Further loss in the contralateral ear (e.g., presbycusis) of PTA or WRS could be applied to the treated ear diminishing the effect attributed to radiation. A formula for this calculation provides for this adjustment 49 . However, due to obtaining frequent post‐treatment audiograms only the involved ear was tested and the contralateral ear was not routinely monitored.…”

“…Yancey et al reviewed their experience with surgery and radiation for VS. 49 At 5 years their estimate for maintaining serviceable hearing (AAO-HNS class A/B) was 28%. Their 10-year Kaplan Meier estimates for preserving serviceable hearing dropped to 14.2%.…”

“…A formula for this calculation provides for this adjustment. 49 However, due to obtaining frequent posttreatment audiograms only the involved ear was tested and the contralateral ear was not routinely monitored. Furthermore, once an audiogram identified the loss to be class D, serial audiograms were often not obtained.…”

Vestibularisschwannom: Faktoren bei der Therapieentscheidung

“…Mehrere Studien zeigten, dass die SRS bei VS von weniger als 3cm im Hinblick auf die Erhaltung des Gesichtsnervs und der Hörfunktion wirksamer ist als die Mikrochirurgie [68,70,72,73,74,75]. Yancey et al beschreiben keinen signifikanten Unterschied des Hörerhalts nach Resektion oder Gamma-Knife-Behandlung bei Erwachsenen mit ausreichender Hörfunktion bei Diagnose [76]. Eine SRS vor Mikrochirurgie geht mit einer erhöhten Morbidität und insbesondere häufigeren Fazialislähmungen einher [77].…”