Small vestibular schwannomas with no hearing: comparison of functional outcomes in stereotactic radiosurgery and microsurgery.
OBJECTIVE
To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium. By studying only patients with small tumors and no hearing, we sought to minimize confounding variables.


METHODS
A retrospective chart review and telephone questionnaire.


METHODS
From 1998-2006, 31 patients with small (<1.5 cm) VS and nonserviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] Class C or D) were treated at our institution. Twenty-two were available for follow-up and telephone questionnaire, including the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ). Twelve underwent SRS and 10 underwent MS. All MS patients underwent the translabyrinthine approach to their tumors. Outcomes measurements included tumor control, facial nerve function, tinnitus, trigeminal function, and imbalance.


RESULTS
Patients undergoing SRS had comparable rates of tumor control, facial nerve function, tinnitus, and trigeminal function to MS patients. However, SRS did result in statistically significantly worse long-term imbalance when compared with MS patients. Detailed comparisons of the two modalities are made.


CONCLUSIONS
In our study population, patients with small tumors and no serviceable hearing, these data suggest that MS results in comparable minimal morbidity with SRS, though posttreatment dysequilibrium is significantly decreased. While the authors recommend translabyrinthine resection of small VS with no hearing in patients able to tolerate surgery, the need for further prospective investigation is clear.
Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Daniel H
DH
Coelho
J Thomas
JT
Roland
Stephen A
SA
Rush
Ashwatha
A
Narayana
Eric
E
St Clair
Wayne
W
Chung
John G
JG
Golfinos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005154:Facial Nerve / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004856:Postural Balance / Q000502:physiology*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014012:Tinnitus / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000503:physiopathology*