1
|
Berger A, AlzateRamirez J, Bernstein K, Mullen R, McMenomey S, Jethanemest D, Friedmann DR, Smouha E, Sulman EP, Silverman JS, Roland JT, Golfinos JG, Kondziolka D. 509 Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
|
2
|
Berger A, Alzate JD, Bernstein K, Mullen R, McMenomey S, Jethanemest D, Friedmann DR, Smouha E, Sulman EP, Silverman JS, Roland JT, Golfinos JG, Kondziolka D. Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery. Neurosurgery 2022; 91:648-657. [PMID: 35973088 PMCID: PMC10553130 DOI: 10.1227/neu.0000000000002090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For patients with vestibular schwannoma (VS), stereotactic radiosurgery (SRS) has proven effective in controlling tumor growth while hearing preservation remains a key goal. OBJECTIVE To evaluate hearing outcomes in the modern era of cochlear dose restriction. METHODS During the years 2013 to 2018, 353 patients underwent Gamma knife surgery for VS at our institution. We followed 175 patients with pre-SRS serviceable hearing (Gardner-Robertson Score, GR 1 and 2). Volumetric and dosimetry data were collected, including biological effective dose, integral doses of total and intracanalicular tumor components, and hearing outcomes. RESULTS The mean age was 56 years, 74 patients (42%) had a baseline GR of 2, and the mean cochlear dose was 3.5 Gy. The time to serviceable hearing loss (GR 3-4) was 38 months (95% CI 26-46), with 77% and 62% hearing preservation in the first and second years, respectively. Patients optimal for best hearing outcomes were younger than 58 years with a baseline GR of 1, free canal space ≥0.041 cc (diameter of 4.5 mm), and mean cochlear dose <3.1 Gy. For such patients, hearing preservation rates were 92% by 12 months and 81% by 2 years, staying stable for >5 years post-SRS, significantly higher than the rest of the population. CONCLUSION Hearing preservation after SRS for patients with VS with serviceable hearing is correlated to the specific baseline GR score (1 or 2), age, cochlear dose, and biological effective dose. Increased tumor-free canal space correlates with better outcomes. The most durable hearing preservation correlates with factors commonly associated with smaller tumors away from the cochlea.
Collapse
Affiliation(s)
- Assaf Berger
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Juan Diego Alzate
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Reed Mullen
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Sean McMenomey
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Daniel Jethanemest
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - David R. Friedmann
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Eric Smouha
- Department of Otolaryngology, Mount Sinai Beth Israel, The Mount Sinai Hospital, New York, New York, USA
| | - Erik P. Sulman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Joshua S. Silverman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - J. Thomas Roland
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - John G. Golfinos
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| |
Collapse
|