Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma

Clinical article

View More View Less
  • 1 Departments of Functional Neurosurgery and
  • 2 Otorhinolaryngology, CHU Timone, APHM;
  • 3 Department of Functional Neurosurgery, INSERM UMR 1106, Aix-Marseille University, Marseille, France; and
  • 4 Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The aim of this study was to perform an accurate analysis of changes in hearing in patients with vestibular schwannoma (VS) who have undergone Gamma Knife surgery (GKS) and distinguish the impact of radiosurgery from the natural course of hearing deterioration due to the tumor itself.

Methods

This study was a retrospective review of prospectively collected patient data. A group of 154 patients with unilateral nonsurgically treated VS was conservatively monitored for more than 6 months and then treated with GKS between July 1997 and September 2005. They were followed up with serial clinical examination, MRI, and audiometry. The annual hearing decrease rate (AHDR) was measured before and after radiosurgery, and the possible prognostic factors for hearing preservation were investigated.

Results

The mean dose prescribed to the tumor margins was 12.1 Gy. The mean radiological follow-up period after GKS was 60 months (range 7–123 months). The tumor control rate was 94.8%, and 8 patients underwent subsequent intervention due to tumor progression. The mean audiological follow-up times before and after GKS were 22 and 52 months, respectively. The mean AHDRs before and after GKS were 5.39 dB/year (95% CI 3.31–7.47 dB/year) and 3.77 dB/year (95% CI 3.13–4.40 dB/year), respectively (p > 0.05). The mean pre- and post-GKS AHDRs in patients who initially had Gardner-Robertson (GR) Class I hearing were −0.57 dB/year (95% CI −2.95 to 1.81 dB/year) and 3.59 dB/year (95% CI 2.52–4.65 dB/year), respectively (p = 0.007). The mean pre- and post-GKS AHDRs in patients who initially had GR Class II hearing were 5.09 dB/year (95% CI 1.36–8.82 dB/year) and 4.98 dB/year (95% CI 3.86–6.10 dB/year), respectively (p > 0.05). A subgroup of 80 patients had both early and late post-intervention AHDR assessment (with early referring to the period from GKS to the assessment closest to the 2-year follow-up point and late referring to the period from that assessment to the most recent one); in these patients, the mean early post-GKS AHDR was 5.86 dB/year (95% CI 4.25–7.50 dB/year) and the mean late post-GKS AHDR was 1.86 dB/year (95% CI 0.77–2.96 dB/year) (p < 0.001). A maximum cochlear dose of less than 4 Gy was found to be the sole prognostic factor for hearing preservation.

Conclusions

The present study demonstrated the absence of an increase in AHDR after radiosurgery as compared with the preoperative AHDR. There was even a trend indicating a reduction in the annual hearing loss after radiosurgery over the long term. To fully elucidate a possible protective effect of radiosurgery, longer-term follow-up with a larger group of patients will be required.

Abbreviations used in this paper:AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; AHDR = annual hearing decrease rate; GKS = Gamma Knife surgery; GR = Gardner-Robertson; PTA = pure-tone average; SDS = speech discrimination score; VS = vestibular schwannoma.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Jean Régis, M.D., APHM, CHU Timone, Service de Neurochirurgie Fonctionnelle, Boulevard Jean Moulin, 13385 Marseille cedex 5, France. email: j.regis@ap-hm.fr.

Please include this information when citing this paper: published online August 31, 2012; DOI: 10.3171/2012.7.JNS10672.

  • 1

    Badie B, , Pyle GM, , Nguyen PH, & Hadar EJ: Elevation of internal auditory canal pressure by vestibular schwannomas. Otol Neurotol 22:696700, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Bakkouri WE, , Kania RE, , Guichard JP, , Lot G, , Herman P, & Huy PT: Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. Clinical article. J Neurosurg 110:662669, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Bozorg Grayeli A, , Kalamarides M, , Ferrary E, , Bouccara D, , El Gharem H, & Rey A, : Conservative management versus surgery for small vestibular schwannomas. Acta Otolaryngol 125:10631068, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Bush ML, , Shinn JB, , Young AB, & Jones RO: Long-term hearing results in gamma knife radiosurgery for acoustic neuromas. Laryngoscope 118:10191022, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Committee on Hearing and Equilibrium: Guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 113:179180, 1995

    • Search Google Scholar
    • Export Citation
  • 6

    Delsanti C, , Tamura M, , Galanaud D, & Régis J: [Changing radiological results, pitfalls and criteria of failure.]. Neurochirurgie 50:312319, 2004. (Fr)

    • Search Google Scholar
    • Export Citation
  • 7

    Flickinger JC, , Kondziolka D, , Niranjan A, & Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94:16, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Flickinger JC, , Kondziolka D, , Niranjan A, , Maitz A, , Voynov G, & Lunsford LD: Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 60:225230, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Foote RL, , Coffey RJ, , Swanson JW, , Harner SG, , Beatty CW, & Kline RW, : Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:11531160, 1995

    • Search Google Scholar
    • Export Citation
  • 10

    Franzin A, , Spatola G, , Serra C, , Picozzi P, , Medone M, & Milani D, : Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas. Neurosurg Focus 27:6 E3, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Gardner G, & Robertson JH: Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:5566, 1988

  • 12

    Graamans K, , Van Dijk JE, & Janssen LW: Hearing deterioration in patients with a non-growing vestibular schwannoma. Acta Otolaryngol 123:5154, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Hajioff D, , Raut VV, , Walsh RM, , Bath AP, , Bance ML, & Guha A, : Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 33:255259, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Hasegawa T, , Fujitani S, , Katsumata S, , Kida Y, , Yoshimoto M, & Koike J: Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 57:257265, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Hayashi M, , Ochiai T, , Nakaya K, , Chernov M, , Tamura N, & Maruyama T, : Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 105:Suppl 511, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Hayashi M, , Ochiai T, , Nakaya K, , Chernov M, , Tamura N, & Yomo S, : Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg 105:Suppl 1217, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Helzner EP, , Cauley JA, , Pratt SR, , Wisniewski SR, , Zmuda JM, & Talbott EO, : Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study. J Am Geriatr Soc 53:21192127, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Horstmann GA, & Van Eck AT: Gamma knife model C with the automatic positioning system and its impact on the treatment of vestibular schwannomas. J Neurosurg 97:5 Suppl 450455, 2002

    • Search Google Scholar
    • Export Citation
  • 19

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146147, 1985

  • 20

    Iwai Y, , Yamanaka K, , Shiotani M, & Uyama T: Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282288, 2003

    • Search Google Scholar
    • Export Citation
  • 21

    Kano H, , Kondziolka D, , Khan A, , Flickinger JC, & Lunsford LD: Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. Clinical article. J Neurosurg 111:863873, 2009

    • Search Google Scholar
    • Export Citation
  • 22

    Kondziolka D, , Lunsford LD, , McLaughlin MR, & Flickinger JC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:14261433, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Lee FS, , Matthews LJ, , Dubno JR, & Mills JH: Longitudinal study of pure-tone thresholds in older persons. Ear Hear 26:111, 2005

  • 24

    Linskey ME, , Lunsford LD, & Flickinger JC: Radiosurgery for acoustic neurinomas: early experience. Neurosurgery 26:736745, 1990

  • 25

    Massager N, , Nissim O, , Delbrouck C, , Delpierre I, , Devriendt D, & Desmedt F, : Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 107:733739, 2007

    • Search Google Scholar
    • Export Citation
  • 26

    Massick DD, , Welling DB, , Dodson EE, , Scholfield M, , Nagaraja HN, & Schmalbrock P, : Tumor growth and audiometric change in vestibular schwannomas managed conservatively. Laryngoscope 110:18431849, 2000

    • Search Google Scholar
    • Export Citation
  • 27

    Mohr G, , Sade B, , Dufour JJ, & Rappaport JM: Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling. J Neurosurg 102:15, 2005

    • Search Google Scholar
    • Export Citation
  • 28

    Nagano O, , Higuchi Y, , Serizawa T, , Ono J, , Matsuda S, & Yamakami I, : Transient expansion of vestibular schwannoma following stereotactic radiosurgery. Clinical article. J Neurosurg 109:811816, 2008

    • Search Google Scholar
    • Export Citation
  • 29

    Niranjan A, , Mathieu D, , Flickinger JC, , Kondziolka D, & Lunsford LD: Hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Neurosurgery 63:10541063, 2008

    • Search Google Scholar
    • Export Citation
  • 30

    Paek SH, , Chung HT, , Jeong SS, , Park CK, , Kim CY, & Kim JE, : Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 104:580590, 2005

    • Search Google Scholar
    • Export Citation
  • 31

    Petit JH, , Hudes RS, , Chen TT, , Eisenberg HM, , Simard JM, & Chin LS: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:12991307, 2001

    • Search Google Scholar
    • Export Citation
  • 32

    Pollock BE, , Lunsford LD, & Norén G: Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 43:475483, 1998

    • Search Google Scholar
    • Export Citation
  • 33

    Prasad D, , Steiner M, & Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745759, 2000

  • 34

    Régis J, , Carron R, , Park MC, , Soumare O, , Delsanti C, & Thomassin JM, : Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. Clinical article. J Neurosurg 113:Suppl 105111, 2010

    • Search Google Scholar
    • Export Citation
  • 35

    Régis J, , Delsanti C, , Roche PH, , Thomassin JM, & Pellet W: [Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature.]. Neurochirurgie 50:301311, 2004. (Fr)

    • Search Google Scholar
    • Export Citation
  • 36

    Régis J, , Hayashi M, , Porcheron D, , Delsanti C, , Muracciole X, & Peragut JC: Impact of the model C and Automatic Positioning System on gamma knife radiosurgery: an evaluation in vestibular schwannomas. J Neurosurg 97:5 Suppl 588591, 2002

    • Search Google Scholar
    • Export Citation
  • 37

    Régis J, , Pellet W, , Delsanti C, , Dufour H, , Roche PH, & Thomassin JM, : Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:10911100, 2002

    • Search Google Scholar
    • Export Citation
  • 38

    Régis J, , Roche PH, , Delsanti C, , Thomassin JM, , Ouaknine M, & Gabert K, : Modern management of vestibular schwannomas. Szeifert GT, , Kondziolka D, & Levivier M, : Radiosurgery and Pathological Fundamentals Basel, Switzerland, Karger Publishers, 2007. 20:129141

    • Search Google Scholar
    • Export Citation
  • 39

    Régis J, , Tamura M, , Delsanti C, , Roche PH, , Pellet W, & Thomassin JM: Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg 21:142151, 2008

    • Search Google Scholar
    • Export Citation
  • 40

    Shigematsu Y, , Korogi Y, , Hirai T, , Okuda T, , Ikushima I, & Sugahara T, : Contrast-enhanced CISS MRI of vestibular schwannomas: phantom and clinical studies. J Comput Assist Tomogr 23:224231, 1999

    • Search Google Scholar
    • Export Citation
  • 41

    Stangerup SE, , Caye-Thomasen P, , Tos M, & Thomsen J: Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma. J Laryngol Otol 122:673681, 2008

    • Search Google Scholar
    • Export Citation
  • 42

    Tamura M, , Carron R, , Yomo S, , Arkha Y, , Muraciolle X, & Porcheron D, : Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with highlevel hearing. Neurosurgery 64:289296, 2009

    • Search Google Scholar
    • Export Citation
  • 43

    Thomas C, , Di Maio S, , Ma R, , Vollans E, , Chu C, & Clark B, : Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose. J Neurosurg 107:917926, 2007

    • Search Google Scholar
    • Export Citation
  • 44

    Timmer FC, , Hanssens PE, , van Haren AE, , Mulder JJ, , Cremers CW, & Beynon AJ, : Gamma knife radiosurgery for vestibular schwannomas: results of hearing preservation in relation to the cochlear radiation dose. Laryngoscope 119:10761081, 2009

    • Search Google Scholar
    • Export Citation
  • 45

    Tlachacova D, , Schmitt M, , Novotny J Jr, , Novotny J, , Majali M, & Liscak R: A comparison of the gamma knife model C and the automatic positioning system with Leksell model B. J Neurosurg 102:Suppl 2528, 2005

    • Search Google Scholar
    • Export Citation
  • 46

    Tschudi DC, , Linder TE, & Fisch U: Conservative management of unilateral acoustic neuromas. Am J Otol 21:722728, 2000

  • 47

    Yomo S, , Arkha Y, , Delsanti C, , Roche PH, , Thomassin JM, & Régis J: Repeat gamma knife surgery for regrowth of vestibular schwannomas. Neurosurgery 64:4855, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 484 266 16
Full Text Views 188 39 4
PDF Downloads 109 32 2
EPUB Downloads 0 0 0