Department of Otorhinolaryngology, Mayo Clinic, School of Medicine, Rochester, Minnesota.
Department of Neurologic Surgery, Mayo Clinic, School of Medicine, Rochester, Minnesota.
Neurosurgery. 2018 Feb 1;82(2):E35-E39. doi: 10.1093/neuros/nyx511.
QUESTION 1: What is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery utilizing modern dose planning, at 2, 5, and 10 yr following treatment?
Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr.
QUESTION 2: Among patients with AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery hearing classification) class A or GR (Gardner-Robertson hearing classification) grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery, utilizing modern dose planning, at 2, 5, and 10 yr following treatment?
Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr.
QUESTION 3: What patient- and tumor-related factors influence progression to nonserviceable hearing following stereotactic radiosurgery using ≤13 Gy to the tumor margin?
Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size, marginal tumor dose ≤12 Gy, and cochlear dose ≤4 Gy. Age and sex are not strong predictors of hearing preservation outcome.
QUESTION 4: What is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment?
Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (>25%-50%) of hearing preservation immediately following surgery, moderately low probability (>25%-50%) of hearing preservation at 2 yr, moderately low probability (>25%-50%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr.
QUESTION 5: Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment?
Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (>50%-75%) of hearing preservation immediately following surgery, moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr.
QUESTION 6: What patient- and tumor-related factors influence progression to nonserviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas?
Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a distal internal auditory canal cerebrospinal fluid fundal cap. Age and sex are not strong predictors of hearing preservation outcome.
QUESTION 7: What is the overall probability of maintaining serviceable hearing with conservative observation of vestibular schwannomas at 2, 5, and 10 yr following diagnosis?
Level 3: Individuals who meet these criteria and are considering observation should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr.
QUESTION 8: Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing with conservative observation at 2 and 5 yr following diagnosis?
Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, and moderately high probability (>50%-75%) of hearing preservation at 5 yr. Insufficient data were available to determine the probability of hearing preservation at 10 yr for this population subset.
QUESTION 9: What patient and tumor-related factors influence progression to nonserviceable hearing during conservative observation?
Level 3: Individuals who meet these criteria and are considering observation should be counseled regarding probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, as well as nongrowth of the tumor. Tumor size at the time of diagnosis, age, and sex do not predict future development of nonserviceable hearing during observation. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_3.
问题 1：在利用现代剂量规划进行立体定向放射外科治疗后，2、5 和 10 年时，保持可听性的总体概率是多少？
3 级：符合这些标准并考虑立体定向放射外科治疗的患者，应该被告知在 2 年内有较高的（>50%-75%）听力保留概率，在 5 年内有较高的（>50%-75%）听力保留概率，在 10 年内有较低的（>25%-50%）听力保留概率。
问题 2：在基线时具有 AAO-HNS（美国耳鼻喉科学-头颈外科学会听力分类）A级或 GR（加德纳-罗伯逊听力分类）I 级听力的患者中，利用现代剂量规划进行立体定向放射外科治疗后，2、5 和 10 年时保持可听性的总体概率是多少？
3 级：符合这些标准并考虑立体定向放射外科治疗的患者，应该被告知在 2 年内有较高的（>75%-100%）听力保留概率，在 5 年内有较高的（>50%-75%）听力保留概率，在 10 年内有较低的（>25%-50%）听力保留概率。
问题 3：哪些患者和肿瘤相关因素会影响立体定向放射外科治疗后听力丧失？
3 级：符合这些标准并考虑立体定向放射外科治疗的患者，应该被告知基于以下预后数据的成功听力保留概率：与可听性维持相关的最一致的预后特征是术前单词识别和/或纯音阈值较好，报告有不同的临界点，肿瘤体积较小，肿瘤边缘剂量≤12Gy，耳蜗剂量≤4Gy。年龄和性别不是听力保留结果的有力预测因素。
问题 4：小型至中型散发性前庭神经鞘瘤手术后立即、2、5 和 10 年时，保持可听性的总体概率是多少？
3 级：符合这些标准并考虑显微切除术的患者，应该被告知在手术后立即有较低的（>25%-50%）听力保留概率，在 2 年内有较低的（>25%-50%）听力保留概率，在 5 年内有较低的（>25%-50%）听力保留概率，在 10 年内有较低的（>25%-50%）听力保留概率。
问题 5：在基线时具有 AAO-HNS 级或 GR 级听力的患者中，小型至中型散发性前庭神经鞘瘤手术后立即、2、5 和 10 年时，保持可听性的总体概率是多少？
3 级：符合这些标准并考虑显微切除术的患者，应该被告知在手术后立即有较高的（>50%-75%）听力保留概率，在 2 年内有较高的（>50%-75%）听力保留概率，在 5 年内有较高的（>50%-75%）听力保留概率，在 10 年内有较低的（>25%-50%）听力保留概率。
问题 6：哪些患者和肿瘤相关因素会影响显微切除术治疗小型至中型散发性前庭神经鞘瘤后听力丧失？
3 级：符合这些标准并考虑显微切除术的患者，应该被告知基于以下预后数据的成功听力保留概率：与可听性维持相关的最一致的预后特征是术前单词识别和/或纯音阈值较好，报告有不同的临界点，肿瘤体积较小，通常小于 1cm，以及存在远端内听道脑脊液基底帽。年龄和性别不是听力保留结果的有力预测因素。
问题 7：诊断后 2、5 和 10 年时，保守观察前庭神经鞘瘤的可听性保持概率是多少？
3 级：符合这些标准并考虑观察的患者，应该被告知在 2 年内有较高的（>75%-100%）听力保留概率，在 5 年内有较高的（>50%-75%）听力保留概率，在 10 年内有较低的（>25%-50%）听力保留概率。
问题 8：在基线时具有 AAO-HNS 级或 GR 级听力的患者中，诊断后 2 和 5 年时，保守观察的可听性保持概率是多少？
3 级：符合这些标准并考虑立体定向放射外科治疗的患者，应该被告知在 2 年内有较高的（>75%-100%）听力保留概率，在 5 年内有较高的（>50%-75%）听力保留概率。对于这一人群亚组，没有足够的数据来确定在 10 年内保持听力的概率。
问题 9：哪些患者和肿瘤相关因素会影响保守观察期间听力丧失？
3 级：符合这些标准并考虑观察的患者，应该被告知基于以下预后数据的成功听力保留概率：与可听性维持相关的最一致的预后特征是术前单词识别和/或纯音阈值较好，报告有不同的临界点，以及肿瘤无生长。诊断时的肿瘤大小、年龄和性别不能预测观察期间听力丧失的未来发展。完整的指南可以在以下网址找到：https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_3。
