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

Neurosurgery. 2019 Oct 1;85(4):550-559. doi: 10.1093/neuros/nyy407.

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 = .040) and with neurofibromatosis type 2 (NF2; P = .017) were associated with poorer hearing (P = .040). Patients with word recognition scores (WRS) of 50% or poorer had tumors with a larger volume (P = .0002), larger linear size (P = .032), and NF2 (P = .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.

Keywords: Hearing; Radiosurgery; Stereotactic; Vestibular schwannoma.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Hearing Tests
  • Hearing*
  • Humans
  • Male
  • Middle Aged
  • Neuroma, Acoustic / surgery*
  • Radiosurgery / methods*
  • Retrospective Studies
  • Treatment Outcome*