Ramin A Morshed, Karl R Khandalavala, James R Dornhoffer, Eric E Babajanian, Ghazal S Daher, John P Marinelli, Paul D Brown, Christine M Lohse, Matthew L Carlson, Michael J Link
{"title":"散发性前庭分裂瘤放射手术后的最小耳蜗剂量对听力的影响。","authors":"Ramin A Morshed, Karl R Khandalavala, James R Dornhoffer, Eric E Babajanian, Ghazal S Daher, John P Marinelli, Paul D Brown, Christine M Lohse, Matthew L Carlson, Michael J Link","doi":"10.3171/2024.7.JNS24789","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>It is uncertain which cochlear dose parameters significantly impact hearing after stereotactic radiosurgery (SRS) for sporadic vestibular schwannoma (VS). The objective of this study was to determine the impact of cochlear dose parameters on hearing outcomes for patients with serviceable hearing (SH).</p><p><strong>Methods: </strong>This was a historical cohort study performed at a single tertiary center that included patients with sporadic VS and SH who underwent single-session Gamma Knife radiosurgery treatment from 2007 to 2022. Associations of cochlear dose parameters with time to non-SH and rates of change in pure-tone average (PTA) and word recognition score (WRS) following SRS were assessed.</p><p><strong>Results: </strong>A total of 205 patients with SH underwent SRS for a sporadic VS. At SRS, 54 (26%) tumors were confined to the internal auditory canal and 151 (74%) extended into the cerebellopontine angle. At 2, 5, and 10 years following SRS, 62%, 37%, and 15% of patients maintained SH, respectively. The median time to non-SH was 1.8 years. The median rates of change in PTA and WRS were 6.0 dB of hearing loss per year and -6.5% per year, respectively. In a multivariable analysis, each 1-Gy increase in minimum cochlear dose was significantly associated with time to non-SH (HR 1.5, 95% CI 1.2-1.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6-6.2), and rate of change in WRS percentage per year (PE -6.4, 95% CI -11.2 to -1.5). The associations of each 1-Gy increase in mean cochlear dose with hearing outcomes were only significant among patients with class B hearing (time to non-SH HR 1.3, 95% CI 1.1-1.6; rate of change in PTA PE 3.6, 95% CI 1.2-5.9; and rate of change in WRS PE -5.7, 95% CI -9.7 to -1.7).</p><p><strong>Conclusions: </strong>The minimum cochlear dose impacts hearing outcomes after SRS for VS and should be considered in radiosurgical treatment planning. 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The objective of this study was to determine the impact of cochlear dose parameters on hearing outcomes for patients with serviceable hearing (SH).</p><p><strong>Methods: </strong>This was a historical cohort study performed at a single tertiary center that included patients with sporadic VS and SH who underwent single-session Gamma Knife radiosurgery treatment from 2007 to 2022. Associations of cochlear dose parameters with time to non-SH and rates of change in pure-tone average (PTA) and word recognition score (WRS) following SRS were assessed.</p><p><strong>Results: </strong>A total of 205 patients with SH underwent SRS for a sporadic VS. At SRS, 54 (26%) tumors were confined to the internal auditory canal and 151 (74%) extended into the cerebellopontine angle. At 2, 5, and 10 years following SRS, 62%, 37%, and 15% of patients maintained SH, respectively. The median time to non-SH was 1.8 years. The median rates of change in PTA and WRS were 6.0 dB of hearing loss per year and -6.5% per year, respectively. In a multivariable analysis, each 1-Gy increase in minimum cochlear dose was significantly associated with time to non-SH (HR 1.5, 95% CI 1.2-1.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6-6.2), and rate of change in WRS percentage per year (PE -6.4, 95% CI -11.2 to -1.5). The associations of each 1-Gy increase in mean cochlear dose with hearing outcomes were only significant among patients with class B hearing (time to non-SH HR 1.3, 95% CI 1.1-1.6; rate of change in PTA PE 3.6, 95% CI 1.2-5.9; and rate of change in WRS PE -5.7, 95% CI -9.7 to -1.7).</p><p><strong>Conclusions: </strong>The minimum cochlear dose impacts hearing outcomes after SRS for VS and should be considered in radiosurgical treatment planning. 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引用次数: 0
摘要
目的：目前尚不确定哪些耳蜗剂量参数会对散发性前庭神经分裂瘤（VS）立体定向放射外科手术（SRS）后的听力产生重大影响。本研究的目的是确定人工耳蜗剂量参数对具有可用听力（SH）患者听力结果的影响：这是一项在单一三级中心进行的历史队列研究，研究对象包括2007年至2022年期间接受单次伽玛刀放射外科治疗的散发性VS和SH患者。评估了耳蜗剂量参数与非SH时间的关系，以及SRS后纯音平均值（PTA）和单词识别评分（WRS）的变化率：共有205名SH患者因散发性VS接受了SRS治疗。在进行 SRS 时，54 例（26%）肿瘤局限于内耳道，151 例（74%）肿瘤扩展至小脑角。SRS后2年、5年和10年，分别有62%、37%和15%的患者保持SH。无SH的中位时间为1.8年。PTA 和 WRS 的中位变化率分别为每年听力损失 6.0 分贝和每年-6.5%。在多变量分析中，最小耳蜗剂量每增加 1-Gy 与非 SH 时间（HR 1.5，95% CI 1.2-1.9）、PTA 分贝听力损失每年变化率（参数估计 [PE]3.4，95% CI 0.6-6.2）和 WRS 百分比每年变化率（PE -6.4，95% CI -11.2--1.5）显著相关。平均人工耳蜗剂量每增加 1-Gy 与听力结果的关系仅在 B 级听力患者中显著（非 SH 时间 HR 1.3，95% CI 1.1-1.6；PTA PE 变化率 3.6，95% CI 1.2-5.9；WRS PE 变化率 -5.7，95% CI -9.7 至 -1.7）：结论：最小耳蜗剂量会影响VS SRS术后的听力结果，在放射外科治疗计划中应加以考虑。在这组患者中，平均耳蜗剂量仅与SRS时听力为B级的亚组患者的听力结果有关。
Minimum cochlear dose impacts hearing after radiosurgery for sporadic vestibular schwannoma.
Objective: It is uncertain which cochlear dose parameters significantly impact hearing after stereotactic radiosurgery (SRS) for sporadic vestibular schwannoma (VS). The objective of this study was to determine the impact of cochlear dose parameters on hearing outcomes for patients with serviceable hearing (SH).
Methods: This was a historical cohort study performed at a single tertiary center that included patients with sporadic VS and SH who underwent single-session Gamma Knife radiosurgery treatment from 2007 to 2022. Associations of cochlear dose parameters with time to non-SH and rates of change in pure-tone average (PTA) and word recognition score (WRS) following SRS were assessed.
Results: A total of 205 patients with SH underwent SRS for a sporadic VS. At SRS, 54 (26%) tumors were confined to the internal auditory canal and 151 (74%) extended into the cerebellopontine angle. At 2, 5, and 10 years following SRS, 62%, 37%, and 15% of patients maintained SH, respectively. The median time to non-SH was 1.8 years. The median rates of change in PTA and WRS were 6.0 dB of hearing loss per year and -6.5% per year, respectively. In a multivariable analysis, each 1-Gy increase in minimum cochlear dose was significantly associated with time to non-SH (HR 1.5, 95% CI 1.2-1.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6-6.2), and rate of change in WRS percentage per year (PE -6.4, 95% CI -11.2 to -1.5). The associations of each 1-Gy increase in mean cochlear dose with hearing outcomes were only significant among patients with class B hearing (time to non-SH HR 1.3, 95% CI 1.1-1.6; rate of change in PTA PE 3.6, 95% CI 1.2-5.9; and rate of change in WRS PE -5.7, 95% CI -9.7 to -1.7).
Conclusions: The minimum cochlear dose impacts hearing outcomes after SRS for VS and should be considered in radiosurgical treatment planning. In this cohort, the mean cochlear dose was only associated with hearing outcomes in the subgroup of patients with class B hearing at SRS.
期刊介绍：
The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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