title: Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery.
abstract: OBJECTIVE
  Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea.
  
  
  METHODS
  Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.5 Gy (range 12.5-13 Gy) to the 50% isodose volume. Audiometry was performed prospectively before and after GKS at 1, 3, and 6 months, and then every 6 months thereafter. Hearing preservation was based on pure tone average (PTA) and speech discrimination (SD). Serviceable hearing was defined as PTA less than 50 dB and SD greater than 50%.
  
  
  RESULTS
  The median cochlear maximum and mean doses were 6.9 Gy (range 1.6-16 Gy) and 2.7 Gy (range 0.7-5.0 Gy), respectively. With a median audiological follow-up of 35 months (range 6-58 months), the 1-, 2-, and 3-year actuarial rates of maintaining serviceable hearing were 93%, 77%, and 74%, respectively. No patient who received a mean cochlear dose less than 2 Gy experienced serviceable hearing loss (p = 0.035). Patients who received a mean cochlear dose less than 3 Gy had a 2-year hearing preservation rate of 91% compared with 59% in those who received a mean cochlear dose of 3 Gy or greater (p = 0.029). Those who had more than 25% of their cochlea receiving 3 Gy or greater had a higher rate of hearing loss (p = 0.030). There was no statistically significant correlation between serviceable hearing loss and age, tumor size, pre-GKS PTA, pre-GKS SD, pre-GKS Gardner-Robertson class, maximum cochlear dose, or the percentage of cochlear volume receiving 5 Gy. On multivariate analysis there was a trend toward significance for serviceable hearing loss with a mean cochlear dose of 3 Gy or greater (p = 0.074). Local control was 100% at 24 months. No patient developed facial or trigeminal nerve dysfunction.
  
  
  CONCLUSIONS
  With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48072, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Baschnagel
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chen
authors.forename: Dennis
authors.initials: D
authors.lastname: Bojrab
authors.forename: Daniel
authors.initials: D
authors.lastname: Pieper
authors.forename: Jack
authors.initials: J
authors.lastname: Kartush
authors.forename: Oksana
authors.initials: O
authors.lastname: Didyuk
authors.forename: Ilka C
authors.initials: IC
authors.lastname: Naumann
authors.forename: Ann
authors.initials: A
authors.lastname: Maitz
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D003051:Cochlea / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000528:radiation effects*; D034381:Hearing Loss / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006320:Hearing Tests; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D012720:Severity of Illness Index; D013067:Speech Perception; D013997:Time Factors