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DOI: 10.1055/s-0039-1679628
Clinical Outcomes for Patients Undergoing Treatment for Vestibular Schwannoma with “Excellent Hearing”
Publikationsverlauf
Publikationsdatum:
06. Februar 2019 (online)
Introduction: Vestibular schwannoma (VS) is estimated to affect ~1 in 100,000 people in the general population. It is a benign, slow-growing tumor of cranial nerve VIII and accounts for >90% of cerebellopontine angle neoplasms. We aim to present the clinical outcomes among patients with has excellent hearing (AOO-HNS hearing class A and B) who undergoing the treatment.
Methods: Patients who underwent treatment for VS at our tertiary care hospital were studied. For stereotactic radiosurgery (SRS) patients from 1997 to 2012 and for microsurgery from 2003 to 2014 were included. A retrospective analysis of prospectively collected data was done. A p-value of <0.05 was considered significant.
Results: In total, 188 patients with VS who had OOA-HNS hearing classes A and B were included. Among them 74 were treated with Cyberknife, 71 with Gamma Knife, and 43 with microsurgery. Patient population who underwent surgery was found to be younger than those of radiosurgery (p < 0.0001). Also, patients who underwent microsurgery had greater tumor volume ([Table 1]). Evaluation of the hearing class showed worsening after the procedure (p < 0.0001). This trend was observed among all treatment modalities, including SRS group ([Fig. 1]). Worsening of House–Brackmann score was more prominent among microsurgical group ([Fig. 2]). This fact was reinstated by the higher proportion of complications among surgical group (25.6%). Improvement in the symptoms of difficulty in balance, tinnitus was observed (p < 0.05).
|
Parameters |
Study population (N = 188)Mean (SD)/n (%) |
Microsurgery (N = 43)Mean (SD)/n (%) |
Radiosurgery (N = 145)Mean (SD)/n (%) |
|---|---|---|---|
|
Age (y) |
50.9 (12.8) |
44.72 (14.1) |
57 (11.6) |
|
Male |
86 (45.7) |
16 (37.2) |
70 (48.3) |
|
AAO-HNS hearing class at diagnosis |
|||
|
A |
132 (70.2) |
39 (90.7) |
93 (64.1) |
|
B |
56 (29.8) |
4 (9.3) |
52 (35.9) |
|
KOOS grade[a] |
|||
|
1 |
44 (24) |
13 (30.2) |
31 (22.1) |
|
2 |
55 (30) |
13 (30.2) |
42 (30) |
|
3 |
53 (29) |
10 (23.3) |
43 (30.7) |
|
4 |
31 (16.9) |
7 (16.3) |
24 (17.1) |
|
Tumor volume (mm3) |
5,517 (1,792.9) |
10,100.5 (11,567.7) |
933.5 (2,429.1) |
|
Prior treatment |
|||
|
Surgery |
10 (5.3) |
0 |
10 (6.9) |
|
Radiosurgery |
24 (12.8) |
23 (53.5) |
1 (0.7) |
|
Postprocedure complications |
17 (9) |
11 (25.6) |
6 (4.1) |
|
Clinical follow-up duration (mo) |
21.35 (28.3) |
11.9 (28) |
30.8 (28.6) |
|
Posttreatment tumor size[b] |
|||
|
Increased |
14 (8.2) |
2 (5.3) |
12 (9) |
|
Decreased |
53 (31) |
15 (39.5) |
38 (28.6) |
|
Stable |
104 (60.8) |
21 (55.3) |
83 (62.4) |
a N = 140 for radiosurgery.
b b N = 38 (surgery), N = 133 (for radiosurgery).
Conclusion: We report the functional outcomes among patients with VS with OOA-HNS hearing class A and B. Disease process was managed successfully as most tumors were found to be stable after the treatment. It is important to note a marked decline in hearing class and HB score among treatment modalities. However, there was a significant improvement in balance and tinnitus. Choosing appropriate treatment modality is critical for improved clinical outcomes.
