Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

• Published in: Journal of clinical neuroscience 2009-06, Vol.16 (6), p.742-747
• Main Authors: Yang, Isaac, Aranda, Derrick, Han, Seunggu J, Chennupati, Sravana, Sughrue, Michael E, Cheung, Steven W, Pitts, Lawrence H, Parsa, Andrew T
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Cochlear Nerve - physiopathology; Cochlear Nerve - radiation effects; Dose-Response Relationship, Radiation; Gamma knife; Hearing Loss - etiology; Hearing Loss - prevention & control; Hearing preservation; Humans; Iatrogenic Disease - prevention & control; Linac; Middle Aged; Neurology; Neuroma, Acoustic - complications; Neuroma, Acoustic - physiopathology; Neuroma, Acoustic - surgery; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Proton beam; Radiosurgery; Radiosurgery - adverse effects; Radiosurgery - methods; Stereotactic radiosurgery; Vestibular Nerve - pathology; Vestibular Nerve - physiopathology; Vestibular Nerve - surgery; Vestibular schwannoma
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2008.09.023

Abstract Radiosurgery has evolved into an effective alternative to microsurgical resection in the treatment of patients with vestibular schwannoma. We performed a systematic analysis of the literature in English on the radiosurgical treatment of vestibular schwannoma patients. A total of 254 published studies reported assessable and quantifiable outcome data of patients undergoing radiosurgery for vestibular schwannomas. American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B and Gardner-Robertson (GR) classification I or II were defined as having preserved hearing. A total of 5825 patients (74 articles) met our inclusion criteria. Practitioners who delivered an average dose of ⩽12.5 Gy as the marginal dose reported having a higher hearing preservation rate (⩽12.5 Gy = 59% vs. >12.5 Gy = 53%, p = 0.0285). Age of the patient was not a significant prognostic factor for hearing preservation rates (65 years = 62%; p = 0.4317). The average overall follow-up was 41.2 months. Our data suggest that an overall hearing preservation rate of about 57% can be expected after radiosurgical treatment, and patients treated with ⩽12.5 Gy were more likely to have preserved hearing.