Predicting hearing outcomes before primary radiosurgery for vestibular schwannomas

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiation Oncology

Background:

• Vestibular schwannomas (VSs) management requires balancing tumor control with functional preservation.
• Stereotactic radiosurgery (SRS) is a key treatment modality for VSs, aiming for tumor control and neurological function preservation.
• Hearing preservation is a critical outcome for patients undergoing VS treatment.

Purpose of the Study:

• To analyze factors influencing hearing preservation rates in patients with serviceable hearing undergoing SRS for VS.
• To evaluate the predictive capability of the Pittsburgh Hearing Prediction Score (PHPS) for long-term hearing outcomes.
• To identify patient and tumor characteristics associated with better hearing preservation post-SRS.

Main Methods:

• Retrospective analysis of 307 patients with serviceable hearing (GR grade 1-2, SDS ≥ 50%, PTA ≤ 50 dB) treated with SRS.
• Evaluation of parameters including age, tumor volume, hearing status, Koos class, and tumor margin dose.
• Assessment of the Pittsburgh Hearing Prediction Score (PHPS) for predicting hearing outcomes.

Main Results:

• High tumor control rate (95%) achieved at a median of 7.6 years post-SRS.
• Serviceable hearing preservation rates were 77.8% at 3 years, 68.8% at 5 years, and 51.8% at 10 years.
• The PHPS effectively predicted hearing preservation: 92.3% at 10 years for PHPS=1 vs. 0% for PHPS=5 (p < 0.001). Younger patients with smaller tumors had better hearing preservation.

Conclusions:

• SRS provides durable tumor control and cranial nerve preservation for vestibular schwannomas.
• The PHPS is a valuable tool for predicting long-term hearing preservation after SRS in patients with serviceable hearing.
• Optimizing hearing preservation involves considering patient age and tumor volume, with younger patients and smaller tumors yielding superior outcomes.