Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery

Reinterpretation of the auditory brainstem response

Authors

  • Jung Ho Han MD,

    1. Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Dong Gyu Kim MD, PhD,

    Corresponding author
    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
    • Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehang-ro Jongno-gu, Seoul 110-744, Korea

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    • Fax: (011) 822-744-8459

  • Hyun-Tai Chung PhD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Sun Ha Paek MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Chul-Kee Park MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Chae-Yong Kim MD,

    1. Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Young-Hoon Kim MD,

    1. Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Jin Wook Kim MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Yong Hwy Kim MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Sang Woo Song MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • In Kyung Kim MD,

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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  • Hee-Won Jung MD

    1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
    2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract

BACKGROUND:

The objective of this study was to identify the prognostic factors for hearing preservation that would allow the more accurate stratification of patients who undergo stereotactic radiosurgery (SRS) for unilateral, sporadic vestibular schwannoma (VS).

METHODS:

In total, 119 patients with VS who had serviceable hearing underwent SRS as primary treatment. The mean (±standard deviation) patient age was 48 ± 11 years, and the mean (±standard deviation) follow-up duration was 55.2 ± 35.7 months. The median marginal radiotherapy dose was 12.0 grays (Gy), and the mean (±standard deviation) tumor volume was 1.95 ± 2.24 cm3. The mean (±standard deviation) pure tone average (PTA) score was 26 ± 12 decibels (dB) (range, 4-50 dB), and the mean (±standard deviation) maximum speech discrimination score was 91 ± 12% (range, 52-100%). The mean (±standard deviation) baseline values for the interlatency (IL) of waves I and III (IL I-III) and the IL of waves I through V (IL I-V) on auditory brainstem response were 2.58 ± 0.60 milliseconds (mS) (range, 1.92-4.30 mS) and 4.80 ± 0.61 mS (range, 3.80-6.40 mS), respectively.

RESULTS:

In multivariate analysis, the PTA score and IL I-V were significant and independent prognostic factors (hazard ratio, 1.072; 95% confidence interval, 1.046-1.098; P < .001; and hazard ratio, 1.534; 95% confidence interval, 1.008-2.336; P = .046, respectively). By using the PTA score and IL I-V, the patients were classified into 4 groups. The ratios of patients with serviceable hearing after SRS were 89.6%, 64.0%, 25.8%, and 6.7%, respectively, in Groups A through D (P < .001).

CONCLUSIONS:

The current results indicated that the classification system based on using the PTA score and the IL I-V of the auditory brainstem response may be useful and specific for predicting the rate of hearing preservation in each individual. Cancer 2012. © 2012 American Cancer Society.

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