Hearing Preservation up to 3 Years After Gamma Knife Radiosurgery for Gardner-Robertson Class I Patients With Vestibular Schwannomas

Mousavi, Seyed H.; Kano, Hideyuki; Faraji, Amir H.; Gande, Abhiram; Flickinger, John C.; Niranjan, Ajay; Monaco, Edward A.; Lunsford, L. Dade

doi:10.1227/neu.0000000000000674

Cited by 22 publications

(10 citation statements)

References 34 publications

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“…8,9,17,20,26 In contrast, recent studies have reported that SRS is associated with high-level hearing preservation rates. 12,18 In our current study, we found that SRS preserves functional hearing at 10 years in up to 98% of patients treated prior to the development of subjective hearing loss.…”

Section: Discussionsupporting

confidence: 51%

“…10 Despite the high tumor control rates, long-term serviceable hearing preservation rates vary from 60% to 90%, depending on the classification system used and the proportion of patients with normal pre-SRS hearing. 7,13,18,21 Some physicians advocate an initial observation interval ("wait and scan" approach) due to the purported slow growth rate of vestibular schwannomas. The effect of delayed intervention on hearing preservation rates has been studied sparingly.…”

Section: Discussionmentioning

confidence: 99%

“…18 Audiograms were requested routinely at either 6-month or 1-year intervals unless a patient reported additional hearing dysfunction during the observation period. Such patients were then requested to undergo repeat MRI and audiograms.…”

Section: Follow-up Evaluationsmentioning

confidence: 99%

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Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

Mousavi¹,

Niranjan²,

Akpinar

et al. 2016

JNS

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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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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

Mousavi¹,

Niranjan²,

Akpinar

et al. 2016

JNS

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“…Very good outcomes for hearing have been reported with stereotactic radiotherapy. 34,41 Careful review of these reports shows that only a subset of patients undergoing treatment have long-term audiometric results. Probably the best series detailing long-term hearing results after stereotactic radiosurgery for VS was published by the Mayo Clinic.…”

Section: Hearingmentioning

confidence: 99%

Translabyrinthine microsurgical resection of small vestibular schwannomas

Schwartz

Leković²,

Miller

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Translabyrinthine resection is one of a number of treatment options available to patients with vestibular schwannomas. Though this procedure is hearing destructive, the authors have noted excellent clinical outcomes for patients with small tumors. The authors review their experience at a tertiary acoustic neuroma referral center in using the translabyrinthine approach to resect small vestibular schwannomas. All operations were performed by a surgical team consisting of a single neurosurgeon and 1 of 7 neurotologists. METHODS Data from a prospectively maintained clinical database were extracted and reviewed. Consecutive patients with a preoperative diagnosis of vestibular schwannoma that had less than 1 cm of extension into the cerebellopontine angle, operated on between 2008 and 2013, were included. Patents with neurofibromatosis Type 2, previous treatment, or preexisting facial weakness were excluded. In total, 107 patients were identified, 74.7% of whom had poor hearing preoperatively. RESULTS Pathologically, 6.5% of patients were found to have a tumor other than vestibular schwannoma. Excluding two malignancies, the tumor control rates were 98.7%, as defined by absence of radiographic disease, and 99.0%, as defined by no need for additional treatment. Facial nerve outcome was normal (House-Brackmann Grade I) in 97.2% of patients and good (House-Brackmann Grade I-II) in 99.1%. Complications were cerebrospinal fluid leak (4.7%) and sigmoid sinus thrombosis (0.9%), none of which led to long-term sequelae. CONCLUSIONS Translabyrinthine resection of small vestibular schwannomas provides excellent results in terms of complication avoidance, tumor control, and facial nerve outcomes. This is a hearing-destructive operation that is advocated for selected patients.

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“…Current treatment possibilities include observation, stereotactic radiosurgery (SRS) and microsurgery (MS) 3 . For intracanalicular tumors, the "wait-and-scan" approach has been further challenged by the proactive SRS treatment 4 , as the former had been suggested to better preserve hearing on long-term basis, especially in patients with high-level of hearing pretherapeutically, absence of subjective hearing loss in patients with Garner-Robertson 1 5 or younger age 6 . In general, small to medium size tumors can be offered SRS.…”

Section: Dear Editormentioning

confidence: 99%

Letter: Postoperative Hearing Preservation in Patients Undergoing Retrosigmoid Craniotomy for Resection of Vestibular Schwannomas: A Systematic Review of 2034 Patients

Tuleasca¹,

Daniel²,

Starnoni³

et al. 2019

Neurosurg.

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Hearing Preservation up to 3 Years After Gamma Knife Radiosurgery for Gardner-Robertson Class I Patients With Vestibular Schwannomas

Cited by 22 publications

References 34 publications

Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

Translabyrinthine microsurgical resection of small vestibular schwannomas

Letter: Postoperative Hearing Preservation in Patients Undergoing Retrosigmoid Craniotomy for Resection of Vestibular Schwannomas: A Systematic Review of 2034 Patients

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