title: Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing.
abstract: OBJECTIVE
  The aim of this study was to evaluate long-term hearing preservation after gamma knife radiosurgery (GKS) for vestibular schwannomas in patients with initially normal or subnormal hearing (Gardner-Robertson Class 1) and to determine the predictive factors for functional hearing preservation.
  
  
  METHODS
  Since July 1992, more than 2053 vestibular schwannomas have been treated by GKS and followed at the Timone University Hospital, Marseille. A minimum of 3 years of follow-up (range, 3-11 years; median, 48 months) is available for 74 patients (without neurofibromatosis Type 2 or previous surgery) with Gardner-Robertson Class 1 hearing.
  
  
  RESULTS
  The average age of the patients was 47.5 years (range, 17-76 years). The number of tumors in Koos Stage I was 8, the average number in Stage II was 21, the average number in Stage III was 43, and the average number in Stage IV was 2. The median number of isocenters was 8 (range, 2-45), and the median marginal dose was 12 Gy (range, 9-13 Gy). At the time of the last follow-up evaluation, 78.4% of the patients had preserved functional hearing. Tumor control was achieved in 93% of the cases. The probability of preserving functional hearing was higher in patients who had an initial symptom other than hearing decrease (91.1%), in patients younger than 50 years (83.7%), and in those treated with a dose to the cochlea of less than 4 Gy (90.9%).
  
  
  CONCLUSIONS
  This study shows that the probability of preserving functional hearing in the long term after GKS for patients presenting with unilateral vestibular schwannomas is very high. The positive predictive factors appear to be young age, an initial symptom other than hearing decrease, and a low dose to the cochlea.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, Hôpital de la Timone, Marseille, France.
authors.forename: Manabu
authors.initials: M
authors.lastname: Tamura
authors.forename: Romain
authors.initials: R
authors.lastname: Carron
authors.forename: Shoji
authors.initials: S
authors.lastname: Yomo
authors.forename: Yasser
authors.initials: Y
authors.lastname: Arkha
authors.forename: Xavier
authors.initials: X
authors.lastname: Muraciolle
authors.forename: Denis
authors.initials: D
authors.lastname: Porcheron
authors.forename: Jean M
authors.initials: JM
authors.lastname: Thomassin
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Roche
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult