Hearing preservation after stereotactic radiosurgery for sporadic intracanalicular vestibular schwannomas classified as Koos grade 1

Abstract

AbstractIntroductionThe mechanism of hearing loss following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs) remains unclear. There is conflicting evidence regarding cochlear nerve damage by transient volume expansion of VSs after radiosurgery and radiation‐induced cochlear damage. This study aimed to investigate whether there is a specific patient population that can achieve definite hearing preservation after SRS for VSs.MethodsA total of 37 consecutive patients with sporadic unilateral intracanalicular VSs and serviceable hearing (Gardner‐Roberson [G‐R] class I or II) were treated with SRS from 2009 to 2023. This is a retrospective study. Survival analysis with Cox regression for hearing deterioration was performed.ResultsThe median age was 55 years old. The median tumor volume was 0.089 cm3, and the median marginal dose was 12.0 Gy. Nonserviceable hearing deterioration occurred in 9 patients (24.3%), with a median onset of 11.9 months after SRS. The actuarial rates of serviceable hearing preservation were 86%, 82%, and 70% at 1, 2, and 3 years after SRS, respectively. In a multivariate analysis, only baseline pure tone average > 30 dB increased the risk of nonserviceable hearing deterioration with significant hazard ratio. There were 13 patients with petit VSs whose tumor volume was smaller than 0.05 cm3, and 11 of them were treated by a 4‐mm single shot with a marginal dose of 12 Gy. None of the 13 patients had nonserviceable hearing deterioration.ConclusionsPetit VSs that can be treated with 4‐mm single or double shots with a marginal dose of 12 Gy may achieve hearing preservation after SRS.