Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA.
J Neurosurg. 2013 Mar;118(3):579-87. doi: 10.3171/2012.9.JNS12919. Epub 2012 Oct 26.
The goals of this retrospective cohort study were as follows: 1) to describe the long-term prevalence and timing of hearing deterioration following low-dose (12- to 13-Gy marginal dose) stereotactic radiosurgery (SRS) for vestibular schwannoma (VS); and 2) to identify clinical variables associated with long-term preservation of useful hearing following treatment.
Patients with serviceable hearing who underwent SRS for VS between 1997 and 2002 were studied. Data including radiosurgery treatment plans, tumor characteristics, pre- and posttreatment pure tone average, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class were collected. Time to nonserviceable hearing was estimated using the Kaplan-Meier method. Univariate and multivariate associations with time to nonserviceable hearing were evaluated using Cox proportional hazards regression models.
Forty-four patients met the study criteria and were included. The median duration of audiometric follow-up was 9.3 years. Thirty-six patients developed nonserviceable hearing at a mean of 4.2 years following SRS. The Kaplan-Meier estimated rates of serviceable hearing at 1, 3, 5, 7, and 10 years following SRS were 80%, 55%, 48%, 38%, and 23%, respectively. Multivariate analysis revealed that pretreatment ipsilateral pure tone average (p < 0.001) and tumor size (p = 0.009) were statistically significantly associated with time to nonserviceable hearing.
Durable hearing preservation a decade after low-dose SRS for VS occurs in less than one-fourth of patients. Variables including preoperative hearing capacity and tumor size may be used to predict hearing outcomes following treatment. These findings may assist in pretreatment risk disclosure. Furthermore, these data demonstrate the importance of long-term follow-up when reporting audiometric outcomes following SRS for VS.
本回顾性队列研究的目的如下：1）描述接受低剂量（边缘剂量 12-13Gy）立体定向放射外科（SRS）治疗前庭神经鞘瘤（VS）后听力恶化的长期发生率和时间；2）确定与治疗后长期保留有用听力相关的临床变量。
研究了 1997 年至 2002 年间接受 SRS 治疗 VS 且具有可听度的患者。收集的数据包括放射外科治疗计划、肿瘤特征、治疗前后纯音平均听阈、言语辨别评分和美国耳鼻喉科学会-头颈外科学会听力分级。使用 Kaplan-Meier 方法估计不可用听力的时间。使用 Cox 比例风险回归模型评估与不可用听力时间相关的单变量和多变量关联。
44 例患者符合研究标准并被纳入。平均随访时间为 9.3 年。36 例患者在 SRS 后平均 4.2 年出现不可用听力。SRS 后 1、3、5、7 和 10 年可听度的 Kaplan-Meier 估计率分别为 80%、55%、48%、38%和 23%。多变量分析显示，治疗前同侧纯音平均听力（p<0.001）和肿瘤大小（p=0.009）与不可用听力时间显著相关。
接受低剂量 SRS 治疗 VS 后 10 年，持久的听力保护在不到四分之一的患者中发生。包括术前听力能力和肿瘤大小在内的变量可用于预测治疗后的听力结果。这些发现可能有助于治疗前的风险披露。此外，这些数据表明，在报告 SRS 治疗 VS 后的听力结果时，需要进行长期随访。
