Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA.
Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA.
Neurosurgery. 2022 Oct 1;91(4):648-657. doi: 10.1227/neu.0000000000002090. Epub 2022 Aug 18.
For patients with vestibular schwannoma (VS), stereotactic radiosurgery (SRS) has proven effective in controlling tumor growth while hearing preservation remains a key goal.
To evaluate hearing outcomes in the modern era of cochlear dose restriction.
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.
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.
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.
对于前庭神经鞘瘤（VS）患者，立体定向放射外科（SRS）已被证明能有效控制肿瘤生长，而保留听力仍是一个关键目标。
评估在限制耳蜗剂量的现代时代 SRS 的听力结果。
在 2013 年至 2018 年期间，我们机构对 353 例 VS 患者进行了伽玛刀手术。我们随访了 175 例术前有可服务性听力（GR 1 和 2）的患者。收集了容积和剂量学数据，包括生物有效剂量、总肿瘤成分和管内肿瘤成分的积分剂量以及听力结果。
平均年龄为 56 岁，74 例（42%）基线 GR 为 2，平均耳蜗剂量为 3.5 Gy。可服务性听力损失（GR 3-4）的时间为 38 个月（95%CI 26-46），第 1 年和第 2 年的听力保留率分别为 77%和 62%。最佳听力结果的患者年龄小于 58 岁，基线 GR 为 1，管腔自由空间≥0.041 cc（直径 4.5 mm），平均耳蜗剂量<3.1 Gy。对于这些患者，12 个月时听力保留率为 92%，2 年时为 81%，SRS 后>5 年保持稳定，明显高于其他人群。
对于有可服务性听力的 VS 患者，SRS 后的听力保留与特定的基线 GR 评分（1 或 2）、年龄、耳蜗剂量和生物有效剂量相关。增加无肿瘤的管腔空间与更好的结果相关。最持久的听力保留与通常与远离耳蜗的较小肿瘤相关的因素相关。
