title: Intratumoral hemorrhage and fibrosis in vestibular schwannoma: a possible mechanism for hearing loss.
abstract: OBJECTIVE
  Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis.
  
  
  METHODS
  From a prospectively collected database, the authors selected all patients with VS who had undergone microsurgical resection as their initial treatment for histopathologically confirmed VS. Histological specimens obtained in 274 of these patients were systematically reviewed by a blinded neuropathologist who graded the extent of microhemorrhage and fibrosis in these tumors. The effect of these variables on preoperative hearing loss was studied using binary logistic regression.
  
  
  RESULTS
  On univariate analysis, patients with extensive intratumoral microhemorrhage or fibrosis (p < 0.0001), patients with larger tumors (p < 0.05), and patients 65 years of age or older (p < 0.05) were significantly more likely to have unserviceable hearing at the time of surgery. On multivariate analysis, only patients with extensive intratumoral microhemorrhage or fibrosis had an increased risk of having unserviceable hearing at the time of surgery (OR 3.72, 95% CI 1.3-10; p = 0.01). Older age and tumor size greater than 3 cm were not statistically significant risk factors for hearing loss, controlling for the effect of microhemorrhage and fibrosis.
  
  
  CONCLUSIONS
  In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 94143, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Rajwant
authors.initials: R
authors.lastname: Kaur
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Kane
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Rutkowski
authors.forename: Isaac
authors.initials: I
authors.lastname: Yang
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Pitts
authors.forename: Tarik
authors.initials: T
authors.lastname: Tihan
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D016208:Databases, Factual; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000473:pathology; D034381:Hearing Loss / Q000209:etiology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000473:pathology*; D011446:Prospective Studies