• World Neurosurg · Oct 2023

    Multicenter Study

    Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-center Study.

    • Steven D Chang, Alexander Muacevic, Andrea L Klein, Jonathan H Sherman, Pantaleo Romanelli, Peter L Santa Maria, Christoph Fuerweger, Bossi ZanettiIsaICyberknife Center, Centro Diagnostico Italiano, Milan, Italy., Giancarlo Beltramo, Yona Vaisbush, Emma Tran, Austin Feng, Hao Teng, Antonio Meola, Iris Gibbs, Antony M Tolisano, Joe Walter Kutz, Zabi Wardak, Lucien A Nedzi, Robert Hong, Don MacRae, Preet Sohal, Elina Kapoor, Parisa Sabet-Rasekh, Sam Maghami, Paola X Moncada, Ashley Zaleski-King, Richard Amdur, and Ashkan Monfared.
    • Department of Neurosurgery, Stanford University, Stanford, California, USA.
    • World Neurosurg. 2023 Oct 1; 178: e24e33e24-e33.

    ObjectiveStereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration.MethodsMulticenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms.ResultsPure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS.ConclusionsDecline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.Copyright © 2023 Elsevier Inc. All rights reserved.

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