Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: a systematic review.
Radiosurgery has evolved into an effective alternative to microsurgical resection in the treatment of patients with vestibular schwannoma. We performed a systematic analysis of the literature in English on the radiosurgical treatment of vestibular schwannoma patients. A total of 254 published studies reported assessable and quantifiable outcome data of patients undergoing radiosurgery for vestibular schwannomas. American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B and Gardner-Robertson (GR) classification I or II were defined as having preserved hearing. A total of 5825 patients (74 articles) met our inclusion criteria. Practitioners who delivered an average dose of 12.5 Gy as the marginal dose reported having a higher hearing preservation rate (12.5 Gy=59% vs. >12.5 Gy=53%, p=0.0285). Age of the patient was not a significant prognostic factor for hearing preservation rates (<65 years=58% vs. >65 years=62%; p=0.4317). The average overall follow-up was 41.2 months. Our data suggest that an overall hearing preservation rate of about 57% can be expected after radiosurgical treatment, and patients treated with 12.5 Gy were more likely to have preserved hearing.
Yang
Isaac
I
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, California 94143, USA.
Aranda
Derrick
D
Han
Seunggu J
SJ
Chennupati
Sravana
S
Sughrue
Michael E
ME
Cheung
Steven W
SW
Pitts
Lawrence H
LH
Parsa
Andrew T
AT
D000367:Age Factors; D000368:Aged; D003056:Cochlear Nerve / Q000503:physiopathology / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D034381:Hearing Loss / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D014725:Vestibular Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery