title: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery.
abstract: OBJECTIVE
  To assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery.
  
  
  METHODS
  Between August 1987 and December 1997, 29 patients with intracanalicular acoustic tumors underwent stereotactic radiosurgery at our center using the Leksell gamma knife (Elekta Instruments, Inc., Atlanta, GA). Fifteen assessable patients had serviceable preradiosurgery hearing (pure tone average, < or = 50 dB; speech discrimination score, > or = 50%). We retrospectively analyzed our hearing results and compared hearing preservation in patients who received a minimal tumor dose of 14 Gy or less versus those who received more than 14 Gy to the tumor margin.
  
  
  RESULTS
  No perioperative patient morbidity or mortality was observed. Serviceable hearing was preserved in 11 (73%) of 15 assessable patients (actuarial rate, 65%). Long-term follow-up demonstrated serviceable hearing preservation in 10 (100%) of 10 patients who received marginal tumor doses of 14 Gy or less but in only one of five patients who received more than 14 Gy. Preradiosurgery Gardner-Robertson class was preserved in 49%, and testable hearing was present in 68% of patients who had any testable hearing at presentation. Five patients demonstrated improvement in hearing (three had serviceable and two had nonserviceable hearing before radiosurgery). No patient developed a facial or trigeminal neuropathy. Seven of 13 patients with preoperative tinnitus continued to experience tinnitus in follow-up. Episodic vertigo continued in 3 of the 11 patients who presented with vertigo.
  
  
  CONCLUSIONS
  Gamma knife radiosurgery (using conformal dose planning, small-beam geometry, and < or = 14 Gy to the margin) prevents tumor growth and achieves excellent hearing preservation rates.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pennsylvania 15213, USA.
authors.forename: A
authors.initials: A
authors.lastname: Niranjan
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
authors.forename: J C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: A
authors.initials: A
authors.lastname: Maitz
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
mesh_terms: D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology; D003056:Cochlear Nerve / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D009464:Neuroma, Acoustic / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D016634:Radiosurgery / Q000295:instrumentation*; D013069:Speech Reception Threshold Test