Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non–vestibular schwannoma neoplasms of the lateral skull base: a cohort study

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  • 1 Departments of Neurologic Surgery,
  • 2 Otorhinolaryngology, and
  • 3 Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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OBJECTIVE

Radiation dose to the cochlea has been proposed as a key prognostic factor in hearing preservation following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). However, understanding of the predictive value of cochlear dose on hearing outcomes following SRS for patients with non-VS tumors of the lateral skull base (LSB) is incomplete. The authors investigated rates of hearing loss following high-dose SRS in patients with LSB non-VS lesions compared with patients with VS.

METHODS

Patients with LSB meningioma or jugular paraganglioma and serviceable pretreatment hearing who underwent SRS treatment during 2007–2016 and received a modiolus dose > 5 Gy were included in a retrospective cohort study, along with a similarly identified control group of consecutive patients with sporadic VS.

RESULTS

Sixteen patients with non-VS tumors and a control group of 43 patients with VS met study criteria. Serviceable hearing, defined as American Academy of Otololaryngology–Head and Neck Surgery class A/B, was maintained in 13 non-VS versus 23 VS patients (81% vs 56%, p = 0.07). All 3 instances of hearing loss in non-VS patients were observed in cerebellopontine angle (CPA) meningiomas. Non-VS with preserved hearing had a median modiolus dose of 6.9 Gy (range 5.7–19.2 Gy), versus 7.4 Gy (range 5.4–7.6 Gy) in those patients with post-SRS hearing loss (p = 0.53). Sporadic VS patients received an overall median modiolus point-dose of 6.8 Gy (range 5.4–11.7 Gy).

CONCLUSIONS

The modiolus dose threshold of 5 Gy does not predict hearing loss in patients with non-VS tumors undergoing SRS, suggesting that dosimetric parameters derived from VS may not be applicable to this population. Differential rates of hearing loss appear to vary by pathology, with paragangliomas and petroclival meningiomas demonstrating decreased risk of hearing loss compared to CPA meningiomas that may directly compress the cochlear nerve similarly to VS.

ABBREVIATIONS AAO-HNS = American Academy of Otololaryngology–Head and Neck Surgery; CPA = cerebellopontine angle; JP = jugular paraganglioma; LSB = lateral skull base; PTA = pure tone average; SDS = speech discrimination score; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia; VS = vestibular schwannoma.

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Contributor Notes

Correspondence Michael J. Link: Mayo Clinic, Rochester, MN. link.michael@mayo.edu.

INCLUDE WHEN CITING Published online July 12, 2019; DOI: 10.3171/2019.4.JNS19201.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Baschnagel AM, Chen PY, Bojrab D, Pieper D, Kartush J, Didyuk O, : Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 118:571578, 2013

    • Search Google Scholar
    • Export Citation
  • 2

    Bhandare N, Jackson A, Eisbruch A, Pan CC, Flickinger JC, Antonelli P, : Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys 76 (3 Suppl):S50S57, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Brown M, Ruckenstein M, Bigelow D, Judy K, Wilson V, Alonso-Basanta M, : Predictors of hearing loss after Gamma Knife radiosurgery for vestibular schwannomas: age, cochlear dose, and tumor coverage. Neurosurgery 69:605614, 2011

    • Search Google Scholar
    • Export Citation
  • 4

    Carlson ML, Jacob JT, Pollock BE, Neff BA, Tombers NM, Driscoll CL, : Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 118:579587, 2013

    • Search Google Scholar
    • Export Citation
  • 5

    Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T: Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 115:10781086, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Iwai Y, Yamanaka K, Ikeda H: Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg 109:804810, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Jacob JT, Carlson ML, Schiefer TK, Pollock BE, Driscoll CL, Link MJ: Significance of cochlear dose in the radiosurgical treatment of vestibular schwannoma: controversies and unanswered questions. Neurosurgery 74:466474, 2014

    • Search Google Scholar
    • Export Citation
  • 8

    Kano H, Awan NR, Flannery TJ, Iyer A, Flickinger JC, Lunsford LD, : Stereotactic radiosurgery for patients with trigeminal neuralgia associated with petroclival meningiomas. Stereotact Funct Neurosurg 89:1724, 2011

    • Search Google Scholar
    • Export Citation
  • 9

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

    • Search Google Scholar
    • Export Citation
  • 10

    Kida Y, Yoshimoto M, Hasegawa T: Radiosurgery for facial schwannoma. J Neurosurg 106:2429, 2007

  • 11

    Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, : Radiosurgery for para-IAC meningiomas: the effect of radiation dose to the cochlea on hearing outcome. Int J Radiat Oncol Biol Phys 84:675680, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Madhok R, Kondziolka D, Flickinger JC, Lunsford LD: Gamma knife radiosurgery for facial schwannomas. Neurosurgery 64:11021105, 2009

  • 13

    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
  • 14

    Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753765, 1999

    • Search Google Scholar
    • Export Citation
  • 15

    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
  • 16

    Pollock BE, Link MJ, Foote RL, Stafford SL, Brown PD, Schomberg PJ: Radiosurgery as primary management for meningiomas extending into the internal auditory canal. Stereotact Funct Neurosurg 82:98103, 2004

    • Search Google Scholar
    • Export Citation
  • 17

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

    • Search Google Scholar
    • Export Citation
  • 18

    Timmer FCA, Hanssens PEJ, van Haren AEP, 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
  • 19

    Zachenhofer I, Wolfsberger S, Aichholzer M, Bertalanffy A, Roessler K, Kitz K, : Gamma-Knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years. Neurosurgery 58:2836, 2006

    • Search Google Scholar
    • Export Citation

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