Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline

Clinical article

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Object

The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment.

Methods

Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology–Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models.

Results

Forty-four patients met the study criteria and were included. The median duration of audiometric follow-up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80%, 55%, 48%, 38%, and 23%, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing.

Conclusions

Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.

Abbreviations used in this paper:AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; CPA = cerebellopontine angle; HR = hazard ratio; NF2 = neurofibromatosis Type 2; PTA = pure tone average; SDS = speech discrimination score; SRS = stereotactic radiosurgery; VS = vestibular schwannoma.

Article Information

Address correspondence to: Michael J. Link, M.D., Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: link.michael@mayo.edu.

Please include this information when citing this paper: published online October 26, 2012; DOI: 10.3171/2012.9.JNS12919.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier graph showing estimated rates of serviceable hearing among 44 patients with unilateral VS treated with low-dose SRS.

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    Kaplan-Meier graph showing estimated rates of serviceable hearing comparing patients with pretreatment AAO-HNS Class A and Class B hearing.

  • View in gallery

    Kaplan-Meier graph showing estimated rates of serviceable hearing comparing patients with sporadic VSs ≤ 1 cm and tumors > 1 cm.

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