Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery

Clinical article

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Object

Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea.

Methods

Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.5 Gy (range 12.5–13 Gy) to the 50% isodose volume. Audiometry was performed prospectively before and after GKS at 1, 3, and 6 months, and then every 6 months thereafter. Hearing preservation was based on pure tone average (PTA) and speech discrimination (SD). Serviceable hearing was defined as PTA less than 50 dB and SD greater than 50%.

Results

The median cochlear maximum and mean doses were 6.9 Gy (range 1.6–16 Gy) and 2.7 Gy (range 0.7–5.0 Gy), respectively. With a median audiological follow-up of 35 months (range 6–58 months), the 1-, 2-, and 3-year actuarial rates of maintaining serviceable hearing were 93%, 77%, and 74%, respectively. No patient who received a mean cochlear dose less than 2 Gy experienced serviceable hearing loss (p = 0.035). Patients who received a mean cochlear dose less than 3 Gy had a 2-year hearing preservation rate of 91% compared with 59% in those who received a mean cochlear dose of 3 Gy or greater (p = 0.029). Those who had more than 25% of their cochlea receiving 3 Gy or greater had a higher rate of hearing loss (p = 0.030). There was no statistically significant correlation between serviceable hearing loss and age, tumor size, pre-GKS PTA, pre-GKS SD, pre-GKS Gardner-Robertson class, maximum cochlear dose, or the percentage of cochlear volume receiving 5 Gy. On multivariate analysis there was a trend toward significance for serviceable hearing loss with a mean cochlear dose of 3 Gy or greater (p = 0.074). Local control was 100% at 24 months. No patient developed facial or trigeminal nerve dysfunction.

Conclusions

With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.

Abbreviations used in this paper:GKS = Gamma Knife surgery; PTA = pure tone average; SD = speech discrimination; VS = vestibular schwannoma; V3 = volume of the cochlea receiving 3 Gy or greater.

Article Information

Address correspondence to: Inga S. Grills, M.D., Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48072. email: igrills@beaumont.edu.

Please include this information when citing this paper: published online December 7, 2012; DOI: 10.3171/2012.10.JNS12880.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Preservation of serviceable hearing. Kaplan-Meier actuarial curve of serviceable hearing preservation in patients with Gardner-Robertson Class I and II hearing.

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    Serviceable hearing preservation according to a mean cochlear dose of 2 Gy. Kaplan-Meier actuarial curves of serviceable hearing preservation in patients with Gardner-Robertson Class I and II hearing who received a mean cochlear dose of less than 2 Gy versus 2 Gy or more (p = 0.035).

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    Serviceable hearing preservation according to a mean cochlear dose of 3 Gy. Kaplan-Meier actuarial curves of serviceable hearing preservation in patients with Gardner-Robertson Class I and II hearing who received a mean cochlear dose of less than 3 Gy versus 3 Gy or more (p = 0.029).

  • View in gallery

    Serviceable hearing preservation according to a V3 less than or equal to 25% or greater than 25%. Kaplan-Meier actuarial curves of serviceable hearing preservation in patients with Gardner-Robertson Class I and II hearing who had a V3 of less than or equal to 25% versus greater than 25% (p = 0.030).

  • View in gallery

    Serviceable hearing preservation according to the use of plugging. Kaplan-Meier actuarial curves of serviceable hearing preservation in patients with Gardner-Robertson Class I and II hearing who received collimator plugging versus no plugging (p = 0.11).

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