Hearing Preservation After Intervention in Vestibular Schwannoma.
Otol Neurotol
; 43(8): e846-e855, 2022 09 01.
Article
em En
| MEDLINE
| ID: mdl-35941601
ABSTRACT
OBJECTIVE:
This study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma. STUDYDESIGN:
Retrospective review.SETTING:
Tertiary academic center. PATIENTS Adults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.INTERVENTIONS:
Gamma Knife, middle cranial fossa, or retrosigmoid approaches. MAIN OUTCOMEMEASURES:
Pure-tone audiometry and speech discrimination scores.RESULTS:
Postintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0-15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67-2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24-35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06-0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively ( p = 0.75).CONCLUSIONS:
After vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neuroma Acústico
Tipo de estudo:
Observational_studies
Limite:
Adult
/
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article