Influencing the Auditory Pathway in Patients with Vestibular Schwannoma Treated with Gamma Knife Radiosurgery

Czech version

Authors: R. Holý ¹; P. Praženica ¹; P. Fundová ¹; D. Kovář ¹; J. Skutil ²; A. Hahn ²
Authors‘ workplace: ORL klinika 3. LF UK a ÚVN – Vojenská FN Praha ¹; ORL klinika 3. LF UK a FN Královské Vinohrady, Praha ²
Published in: Cesk Slov Neurol N 2014; 77/110(2): 223-229
Category: Short Communication

Overview

Objectives:
To evaluate preservation of the auditory pathway with pure-tone audiometry and brainstem evoked audiometry (BERA) in patients with vestibular schwannoma before and after treatment with Leksell gamma knife.

Population and method:
Twenty seven patients with vestibular schwannoma treated between 1999 and 2009. Pure-tone audiometry applying Gardner-Robertson scale and BERA were recorded.

Results:
During the 6-year observation, 50% patients had serviceable hearing after treatment. Before treatment, 67% patients had usable hearing level, and 93% patients had pathological BERA. Hearing deterioration was statistically significant in all frequencies (p = 0.05). Ipsilateral prolongations of the latency of waves V, III, and I were statistically significant at 80/90dB levels (p = 0,001) in 89%, 81%, and 48% patients, respectively. Interaural pathological I–V interval difference was statistically significant in 85% patients (p = 0.001), interaural III–V interval difference reached statistical significance in 74% patients (p = 0.01). After treatment, BERA detected statistically significant difference at 80/90 dB level only for the wave V (p = 0.05).

Conclusion:
BERA remains reliable screening diagnostic method. Its reliability of 93% exceeds reliability of vestibular tests. Comprehensive assessment of all monitored parameters is fundamental. By incorporating pure-tone audiometry and BERA before radiosurgery, we can reliably detect whether the function of the auditory pathway is affected in patients with vestibular schwannoma of all degrees. Follow-up pure-tone audiometry is statistically significant in patients with vestibular schwannoma after gamma-knife procedure and reliably assesses preservation of the auditory pathway as well as it demonstrates distinct and statistically significant loss of serviceable hearing. Conversely, BERA remains statistically unchanged except for latency of wave V.

Key words:
vestibular schwannoma – acoustic evoked brain stem potential – pure-tone audiometry – gamma knife radiosurgery

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Betka J, Zvěřina E, Lisý J, Chovanec M, Kluh J, Kraus J.Vestibulární schwannom. Otorinolaryng a Foniat / Prague/ 2008; 57(4): 221– 225.

2. Kluh J, Vrabec P, Kuchynková Z. Současný význam evokovaných sluchových potenciálů při audiometrickém vyšetření sluchu. Prakt Lék 1999; 79(12): 675– 678.

3. Šmilauer T, Kluh J, Zvěřina E, Betka J. Přínos BERA k diagnostice neurinomu akustiku. Otorinolaryng a Foniat / Prague/ 2001; 50(2): 99– 102.

4. Koos WT, Day JD, Matula C, Levy DI. Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 1998; 88(3): 506– 512.

5. Holý R, Skutil J, Navara M, Praženica P, Fundová P, Hahn A. Úloha neurootologa v záchytu poradiačních komplikací u pacientů s vestibulárním schwannomem léčených Leksellovým gama nožem. Cesk Slov Neurol N 2013; 76/ 109(2): 191– 196.

6. Holý R, Navara M, Došel P, Fundová P, Praženica P,Hahn A. Hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss (ISSNHL) in association with combined treatment. Undersea Hyperb Med 2011; 38(2): 137– 142.

7. Mejzlík J, Chrobok V, Jelínková H. Porucha sluchu vzniklá po zasažení bleskem. Otorinolaryng Foniat / Prague/ 2011; 60(1): 46– 50.

8. Astl J, Popelár J, Kvasnák E, Syka J. Comparison of response properties of neurons in the inferior colliculus of guinea pigs under different anesthetics. Audiology. 1996; 35(6): 335–345.

9. Bareš K, Šonka K, Navara M, Taudy M, Hahn A. Nový pohled na některá diagnostická kritéria vyšetření BERA. Cesk Otolaryngol 1990; 39(3): 141– 145.

10. Maurer J. The role of brain stem evoked potentials in acoustic neuroma screening and diagnosis. Laryngorhinootologie 2008; 87(8): 585– 596. doi: 10.1055/ s‑ 2008– 1077429.

11. Stejskal L (eds). Evokované odpovědi a jejich klinické využití. 1st ed. Praha: Praha Publishing 1993.

12. Selters WA, Brackmann DE. Acoustic tumor detection with brainstem electric response audiometry. Arch Otolaryngol 1977; 103(4): 181– 187.

13. Syka J, Voldřich L. Vnitřní ucho – struktura a funkce vnitřního ucha. In: Syka J, Voldřich L, Vrabec R (eds). Fyziologie a patofyziologie zraku a sluchu. 1st ed. Praha: Avicenum 1981: 186– 202.

14. Liščák R, Vladyka V, Urgošík D, Šimonová G, Vymazal J. Repeated treatment of vestibular schwannomas after gamma knife radiosurgery. Acta Neurochir (Wien) 2009; 151(4): 317– 324. doi: 10.1007/ s00701– 009– 0254– 0.

15. Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102 (Suppl): 195– 199.

16. Baschnagel AM, Chen PY, Bojrab D, Pieper D, Kartush J, Didyuk O et al. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013; 118(3): 571– 578. doi: 10.3171/ 2012.10.JNS12880.

17. Carlson ML, Jacob JT, Pollock BE, Neff BA, Tombers NM, Driscoll CL et al. Long‑term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 2013; 118(3): 579– 587. doi: 10.3171/ 2012.9.JNS12919.

18. Combs SE, Welzel T, Kessel K, Habermehl D, Rieken S, Schramm O et al. Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients‘ self‑ reported outcome. Radiother Oncol 2013; 106(2): 175– 180. doi: 10.1016/ j.radonc.2012.12.004.

19. Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 2011; 115(6): 1078– 1086. doi: 10.3171/ 2011.7.JNS11749.

20. Delbrouck C, Hassid S, Choufani G, De Witte O,Devriendt D, Massager N. Hearing outcome after gamma knife radiosurgery for vestibular schwannoma: a prospective Belgian clinical study. B‑ ENT 2011; 7 (Suppl 17): 77– 84.

21. Kim CH, Chung KW, Kong DS, Nam DH, Park K, Kim JH et al. Prognostic factors of hearing preservation after gamma knife radiosurgery for vestibular schwannoma. J Clin Neurosci 2010; 17(2): 214– 218. doi: 10.1016/ j.jocn.2009.07.087.

22. Franzin A, Spatola G, Serra C, Picozzi P, Medone M, Milani D et al. Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas. Neurosurg Focus 2009; 27(6): E3. doi: 10.3171/ 2009.9.FOCUS09196.

23. Timmer FC, Hanssens PE, van Haren AE, Mulder JJ,Cremers CW, Beynon AJ et al. Gamma knife radiosurgery for vestibular schwannomas: results of hearing preservation in relation to the cochlear radiation dose. Laryngoscope 2009; 119(6): 1076– 1081. doi: 10.1002/ lary.20245.

24. Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D et al. Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high‑level hearing. Neurosurgery 2009; 64(2): 289– 296. doi: 10.1227/ 01.NEU.0000338256.87936.7C.

25. Bertalanffy A, Dietrich W, Aichholzer M, Brix R, Ertl A, Heimberger K et al. Gamma knife radiosurgery of acoustic neurinomas. Acta Neurochir (Wien) 2001; 143(7): 689– 695.

26. Holý R. Komentář k práci P. Kalitové et al. Význam vestibulárního a posturografického vyšetření u pacientů s vestibulárním schwannomem. Cesk Slov Neurol N 2013; 76/ 109(4): 475– 476.

27. Yomo S, Carron R, Thomassin JM, Roche PH, Régis J. Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma. J Neurosurg 2012; 117(5): 877– 885. doi: 10.3171/ 2012.7.JNS10672.