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Radiosurgery of vestibular schwannoma: prognostic factors for hearing outcome using 3D-constructive interference in steady state (3D-CISS)

Radiochirurgie bei Vestibularisschwannom: Prognostische Faktoren für das Hörvermögen bei Akquisition der 3D-CISS

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Abstract

Purpose

Stereotactic radiosurgery (SRS) is an effective treatment for vestibular schwannoma (VS). Three-dimensional (3D) constructive interference in steady state (CISS) is the preferred magnetic resonance imaging (MRI) sequence for evaluating signal changes in the inner ear endolymph. Previous studies demonstrated a correlation between pretreatment cochlear signal intensity in 3D-CISS and posttherapeutic hearing outcomes. The purpose of our study was to compare 3D-CISS sequences before and after primary SRS of unilateral VSs to evaluate the effect of radiosurgery on the 3D-CISS signal intensities of cochlea and sacculus/utriculus.

Methods

We retrospectively reviewed 47 patients with unilateral VS treated with SRS. The neuroradiological MRI datasets were analysed to evaluate the signal intensity of the inner ear structure, tumour size, Koos grade, tumour volume, and infiltration of the cochlear aperture before therapy and at follow-up. The differences in these signal intensities before SRS and at follow-up were correlated with clinical symptoms, cochlear radiation dose, tumour volume and infiltration of the cochlear aperture.

Results

No differences were found between signal intensities in cochlea and utriculus/sacculus before and after SRS and no correlation with clinical symptoms, cochlear radiation dose, tumour volume, Koos grade or infiltration of the cochlear aperture (all p > 0.05).

Conclusion

Our study supports the theory of a complex interaction causing alteration of the endolymph protein concentration and not a direct dependency on the SRS. Use of modern dosing schemes will have a positive impact on clinical outcome with preservation of hearing in patients with VS.

Zusammenfassung

Ziel

Stereotaktische Radiochirurgie („stereotactic radiosurgery“, SRS) ist effektiv zur Behandlung des Vestibularisschwannoms (VS). Die 3‑D-CISS-Sequenz („constructive interference in steady state“) ist die Sequenz der Wahl bei der Magnetresonanztomographie (MRT) zur Auswertung von Signalveränderungen der Endolymphe des Innenohrs. Frühere Studien zeigten eine Korrelation zwischen der Signalintensität der Cochlea in der 3‑D-CISS vor Strahlentherapie und dem Hörvermögen nach Bestrahlung. Ziel der vorliegenden Studie war der Vergleich der Signalintensität von Cochlea sowie Sacculus/Utriculus in der 3‑D-CISS-Sequenz vor und nach primärer SRS.

Methoden

Retrospektiv wurden 47 Patienten mit einseitigem VS und SRS-Therapie untersucht. Eine neuroradiologische Analyse der initialen und Verlaufs-MRT mit 3‑D-CISS erfolgte, um die Signalintensität des Innenohrs, Tumorgröße, den Koos-Grad, das Tumorvolumen und die Infiltration der Cochlea-Apertur vor SRS und im Verlauf zu evaluieren. Die Unterschiede der Signalintensität vor SRS und bei der Nachuntersuchung wurden mit den klinischen Symptomen, der applizierten Strahlendosis an der Cochlea, dem Tumorvolumen und der Infiltration der Apertura cochlearis korreliert.

Ergebnisse

Es wurden weder Unterschiede zwischen der Signalintensität in Cochlea und Utriculus/Sacculus vor und nach SRS noch eine Korrelation mit klinischen Symptomen, cochleärer Strahlendosis, Tumorvolumen, Koos-Grad oder Infiltration der Cochlea-Apertur festgestellt (alle p > 0,05).

Schlussfolgerung

Die Studie stützt die Theorie einer komplexen Wechselwirkung, die zur Veränderung der Proteinkonzentration der Endolymphe führt, und nicht die direkte Abhängigkeit von der SRS. Diesen Daten zufolge hat die Anwendung moderner Dosierungsschemata einen positiven Einfluss auf das klinische Ergebnis mit Erhalt des Hörvermögens bei VS-Patienten.

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Abbreviations

3D-CISS:

Three-dimensional constructive interference in steady state

CPA:

Cerebellopontine angle

CSF:

Cerebrospinal fluid

dB:

Decibel

FLAIR:

Fluid-attenuated inversion recovery

FoV:

Field of view

Gy:

Gray

IAC:

Internal auditory canal

LVA:

Large vestibular aqueduct syndrome

MPR:

Multiplanar reconstruction

PTA:

Pure-tone audiometry

SRS:

Stereotactic radiosurgery

ST:

Slice thickness

TE:

Echo time

TR:

Repetition time

VS:

Vestibular schwannoma

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, Freiburgstraße 4, 3010, Bern, Switzerland

    Franca Wagner MD, Matteo Gandalini, Arsany Hakim MD, Martin Zbinden & Roland Wiest MD

  2. Departments of Radiology, Radiotherapie and Radiology Practice, Konstanz, Germany

    Matteo Gandalini

  3. Departments of Radiation Oncology, Inselspital, University of Bern, Bern, Switzerland

    Ekin Ermis MD, Dominic Leiser MD & Evelyn Herrmann MD

  4. Departments of Otorhinolaryngology and Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland

    Lukas Anschuetz MD & Marco Caversaccio MD

  5. Departments of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland

    Andreas Raabe MD

Authors
  1. Franca Wagner MD
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  2. Matteo Gandalini
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  3. Arsany Hakim MD
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  4. Ekin Ermis MD
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  5. Dominic Leiser MD
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  6. Martin Zbinden
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  7. Lukas Anschuetz MD
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  8. Andreas Raabe MD
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  9. Marco Caversaccio MD
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  10. Roland Wiest MD
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  11. Evelyn Herrmann MD
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Corresponding author

Correspondence to Franca Wagner MD.

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Conflict of interest

F. Wagner, M. Gandalini, A. Hakim, E. Ermis, D. Leiser, M. Zbinden, L. Anschuetz, A. Raabe, M. Caversaccio, R. Wiest and E. Herrmann declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards.

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Wagner, F., Gandalini, M., Hakim, A. et al. Radiosurgery of vestibular schwannoma: prognostic factors for hearing outcome using 3D-constructive interference in steady state (3D-CISS). Strahlenther Onkol 194, 1132–1143 (2018). https://doi.org/10.1007/s00066-018-1361-8

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