Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The emerging role of hearing loss rehabilitation in patients with vestibular schwannoma treated with Gamma Knife radiosurgery: literature review

Abstract

Stereotactic radiosurgery (SRS) is currently the most common treatment for small- to medium-size vestibular schwannoma (VS). Despite favorable outcome, hearing deterioration still remains an underestimated problem, and the role of hearing rehabilitation is an underinvestigated topic. Among available technologies, cochlear implant (CI) should represent a valid alternative in sporadic VS with single-sided deafness and in neurofibromatosis (NF2) with bilateral profound hearing loss. A literature review of the current clinical data was performed searching scientific literature databases. From all of the articles found, 16 papers were selected. Forty-four subjects treated with radiosurgery (18 male, 19 female, and in 7 cases, sex were not specified; 43 NF2 and 1 sporadic VS) were included in the analysis. Epidemiological, clinical, tumor, treatment, and audiological data were collected. Clinical outcome at last follow-up showed an audiological improvement in 25 of the 44 patients. The audiological outcome was unchanged in 16 cases. Audiological deterioration was recorded in 3 cases. Severity of NF2 phenotype, long history of ipsilateral profound deafness before implantation, progressive tumor growth, and high radiation dose (20 and 40 Gy) were found in patients with a worst audiological outcome. Hearing rehabilitation can improve audiological results for VS patients following SRS in selected cases. Hearing rehabilitation with cochlear implant (CI) in SSD leads to partial restoration of binaural hearing with an improvement in speech comprehension in noise and in sound localization, and partial suppression of subjective incapacitating tinnitus. SRS followed by CI may represent in selected cases a potential emerging option in the management of these patients, aimed at improving their quality of life. Possible implications for the follow-up of these patients are still present, although partially resolved.

This is a preview of subscription content, log in to check access.

Fig. 1

Data availability

Data collected are published and available in the public domain.

References

  1. 1.

    Evans DG, Moran A, King A, Saeed S, Gurusinghe N, Ramsden R (2005) Incidence of vestibular schwannoma and neurofibromatosis 2 in the North West of England over a 10-year period: higher incidence than previously thought. Otol Neurotol 26(1):93–97

  2. 2.

    Plotkin SR, Stemmer-Rachamimov AO, Barker FG II, Halpin C, Padera TP, Tyrrell A, Sorensen AG, Jain RK, di Tomaso E (2009) Hearing improvement after bevacizumab in patients with neurofibromatosis type 2. N Engl J Med 361(4):358–367

  3. 3.

    Bailo M, Boari N, Franzin A, Gagliardi F, Spina A, del Vecchio A, Gemma M, Bolognesi A, Mortini P (2016) Gamma Knife radiosurgery as primary treatment for large vestibular Schwannomas: clinical results at long-term follow-up in a series of 59 patients. World Neurosurg 95:487–501

  4. 4.

    Carlson ML, Habermann EB, Wagie AE, Driscoll CL, Van Gompel JJ, Jacob JT, Link MJ (2015) The changing landscape of vestibular schwannoma management in the United States--a shift toward conservatism. Otolaryngol Head Neck Surg 153(3):440–446

  5. 5.

    Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, McElveen JT Jr et al (2013) Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery 72(2 Suppl Operative):ons103–ons115

  6. 6.

    McClelland S III, Guo H, Okuyemi KS (2011) Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro-Oncology 13:1252–1259

  7. 7.

    Yang I, Aranda D, Han SJ, Chennupati S, Sughrue ME, Cheung SW, Pitts LH, Parsa AT (2009) Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: a systematic review. J Clin Neurosci 16:742–747

  8. 8.

    Maniakas A, Saliba I (2012) Microsurgery versus stereotactic radiation for small vestibular schwannoma: a meta-analysis of patients with more than 5 years’ follow -up. Otol Neurotol 33:1611–1620

  9. 9.

    Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, Del Vecchio A, Bolognesi A, Picozzi P, Mortini P (2014) Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 121(Suppl 2):123–142

  10. 10.

    Pollock BE, Driscoll CL, Foote RL et al (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85

  11. 11.

    Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A (2013) What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 3:e 001345

  12. 12.

    Liu W, Ni M, Jia W, Zhou D, Zhang Q, Jiang Y, Jia G (2015) How to address small- and medium-sized acoustic neuromas with hearing: a systematic review and decision analysis. World Neurosurg 84:283–291

  13. 13.

    Sidiqi B, Sheth N, Lee A, Safdieh J, Schreiber D (2018) Patterns of stereotactic radiotherapy utilization and fractionation for acoustic neuroma in the United States. J Radiosurg SBRT 5(3):201–207

  14. 14.

    Arthurs BJ1, Fairbanks RK, Demakas JJ, Lamoreaux WT, Giddings NA, Mackay AR, Cooke BS, Elaimy AL, Lee CM (2011) A review of treatment modalities for vestibular schwannoma. Neurosurg Rev 34(3):265–277. https://doi.org/10.1007/s10143-011-0307-8

  15. 15.

    Neary WJ, Hillier VF, Flute T et al (2010) Use of a closed set questionnaire to measure primary and secondary effects of neurofibromatosis type 2. J Laryngol Otol 124:720Y8

  16. 16.

    Carillo C, Kiening M, Bergheimer S, Kalamarides M (2018) Psychological follow-up care of neurofibromatosis type 2 patients and their relatives. Neurochirurgie. 64(5):381–385

  17. 17.

    van Leeuwen JP, Braspenning JC, Meijer H et al (1996) Quality of life after acoustic neuroma surgery. Ann Otol Rhinol Laryngol 105:423–430

  18. 18.

    Zeitler DM, Dorman MF (2019) Cochlear implantation for single-sided deafness: a new treatment paradigm. J Neurol Surg B Skull Base 80:178–186

  19. 19.

    Ramsden R, Khwaja S, Green K et al (2005) Vestibular schwannoma in the only hearing ear: cochlear implant or auditory brainstem implant? Otol Neurotol 26:261Y4

  20. 20.

    Vermeire K, Van de Heyning P (2009) Binaural hearing after cochlear implantation in subjects with unilateral sensorineural deafness and tinnitus. Audiol Neurotol 14:163–171

  21. 21.

    Wie OB, Pripp AH, Tvete O (2010) Unilateral deafness in adults: effects on communication and social interaction. Ann Otol Rhinol Laryngol 119(11):772–781

  22. 22.

    Dwyer NY, Firszt JB, Reeder RM (2014) Effects of unilateral input and mode of hearing in the better ear: self-reported performance using the speech, spatial and qualities of hearing scale. Ear Hear 35(1):126–136

  23. 23.

    Hassepass F, Arndt S, Aschendorff A, Laszig R, Wesarg T (2016) Cochlear implantation for hearing rehabilitation in single sided deafness after translabyrinthine vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 273:2373–2383

  24. 24.

    Dagna F, Murri A, Albera R (2016) Cuda D Cochlear implantation in delayed sudden hearing loss after conservative vestibular schwannoma surgery. Acta Otorhinolaryngol Ital 36(5):428–430

  25. 25.

    Amoodi HA, Makki FM, Cavanagh J, Maessen H, Bance M (2012) Cochlear implant rehabilitation for patients with vestibular schwannoma: report of two cases. Cochlear Implants Int 13(2):124–127

  26. 26.

    Carlson ML, Breen JT, Driscoll CL, Link MJ, Neff BA, Gifford RH, Beatty CW (2012) Cochlear implantation in patients with neurofibromatosis type 2: variables affecting auditory performance. Otol Neurotol 33:853–862

  27. 27.

    Lustig LR, Yeagle J, Driscoll CLW, Blevins N, Francis H, Niparko JK (2006) Cochlear implantation in patients with neurofibromatosis type 2 and bilateral vestibular schwannoma. Otol Neurotol 27(4):512–518

  28. 28.

    Mallory GW, Pollock BE, Foote RL, Carlson ML, Driscoll CL, Link MJ (2014) Stereotactic radiosurgery for neurofibromatosis 2-associated vestibular schwannomas: toward dose optimization for tumor control and functional outcomes. Neurosurgery. 74(3):292–300

  29. 29.

    Trotter MI, Briggs RJ (2010) Cochlear implantation in neurofibromatosis type 2 after radiation therapy. Otol Neurotol 31(2):216–219

  30. 30.

    Roehm PC, Mallen-St Clair J, Jethanamest D et al (2011) Auditory rehabilitation of patients with neurofibromatosis type 2 by using cochlear implants. J Neurosurg 115:827–834

  31. 31.

    Tran Ba Huy P, Kania R, Frachet B, Poncet C, Legac MS (2009) Auditory rehabilitation with cochlear implantation in patients with neurofibromatosis type 2. Acta Otolaryngol 129:971–975

  32. 32.

    Lassaletta L, Aristegui M, Medina M, Aranguez G, Pérez-Mora RM, Falcioni M, Gavilán J, Piazza P, Sanna M (2016) Ipsilateral cochlear implantation in patients with sporadic vestibular schwannoma in the only or best hearing ear and in patients with NF2. Eur Arch Otorhinolaryngol 273:27–35

  33. 33.

    Harris F, Tysome JR, Donnelly N, Durie-Gair J, Crundwell G, Tam YC, Knight RD, Vanat ZH, Folland N, Axon P (2017) Cochlear implants in the management of hearing loss in neurofibromatosis type 2. Cochlear Implants Int 18(3):171–179

  34. 34.

    Costello MS, Golub JS, Barrord JV, Pater L, Pensak ML, Samy RN (2016) Cochlear implantation after radiation therapy for acoustic neuroma. J Radiosurg SBRT 4(1):69–74

  35. 35.

    Carlson ML, Neff BA, Sladen DP, Link MJ, Driscoll CL (2016) Cochlear implantation in patients with intracochlear and intralabyrinthine schwannomas. Otol Neurotol 37(6):647–653

  36. 36.

    Mukherjee P, Ramsden JD, Donnelly N, Axon P, Saeed S, Fagan P, Irving RM (2013) Cochlear implants to treat deafness caused by vestibular schwannomas. Otol Neurotol 34:1291–1129

  37. 37.

    Pisa J, Sulkers J, Butler JB, West M, Hochman JB (2017) Stereotactic radiosurgery does not appear to impact cochlear implant performance in patients with neurofibromatosis type II. J Radiosurg SBRT 5(1):63–71

  38. 38.

    Tan H, Jia H, Li Y, Zhang Z, Zhu W, Cai Y, Wang WH (2018) Impact of cochlear implantation on the management strategy of patients with neurofibromatosis type 2. Eur Arch Otorhinolaryngol 275(11):2667–2674

  39. 39.

    Peng KA, Lorenz MB, Otto SR, Brackmann DE, Wilkinson EP (2018) Cochlear implantation and auditory brainstem implantation in neurofibromatosis type 2. Laryngoscope. 128(9):2163–2169

  40. 40.

    Pai I, Dhar V, Kelleher C, Nunn T, Connor S, Jiang D, O’Connor AF (2013) Cochlear implantation in patients with vestibular schwannoma: a single United Kingdom center experience. Laryngoscope. 123(8):2019–2023

  41. 41.

    Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40:248–262

  42. 42.

    Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66

  43. 43.

    (1995) Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma): American Academy of Otolaryngology-Head Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 113(3):179–180. https://doi.org/10.1016/S0194-5998(95)70101-X

  44. 44.

    Johnson S, Kano H, Faramand A, Pease M, Nakamura A, Hassib M et al (2019 Nov) Long term results of primary radiosurgery for vestibular schwannomas. J Neuro-Oncol 145(2):247–255

  45. 45.

    Massager N, Nissim O, Delbrouck C, Devriendt D, David P, Desmedt F et al (2006) Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. Int J Radiat Oncol Biol Phys 64:1331–1340

  46. 46.

    Yang I, Sughrue ME, Han SJ, Aranda D, Pitts LH, Cheung SW, Parsa AT (2010) A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. J Neurosurg 112:851–859

  47. 47.

    Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM (2008) Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg 21:142–151

  48. 48.

    Pan S-Y, Liu S-A, Sun M-H, Tsou H-K, Lee S-D, Chen Y-J, Sheehan J, Sheu M-L, Pan H-C (2017) Outcome of hearing preservation related to tumor morphologic analysis in acoustic neuromas treated by gamma knife radiosurgery. Radiat Oncol 12:134

  49. 49.

    Horiba A, Hayashi M, Chernov M, Kawamata T, Okada Y (2016) Hearing preservation after low-dose Gamma Knife radiosurgery of vestibular schwannomas. Neurol Med Chir (Tokyo) 56:186–192

  50. 50.

    Hayden Gephart MG, Hansasuta A, Balise RR, Choi C, Sakamoto GT, Venteicher AS, Soltys SG, Gibbs IC, Harsh GR, Adler JR, Chang SD (2013) Cochlea radiation dose correlates with hearing loss after stereotactic radiosurgery of vestibular schwannoma. World Neurosurg 80(3–4):359–363

  51. 51.

    Frischer JM, Gruber E, Schöffmann V, Ertl A, Höftberger R, Mallouhi A, Wolfsberger S, Arnoldner C, Eisner W, Knosp E, Kitz K, Gatterbauer B (2018) Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg 2:1–10. https://doi.org/10.3171/2017.8.JNS171281

  52. 52.

    Kano H, Kondziolka D, Khan A, Flickinger JC, Lunsford LD (2009) Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 111:863–873

  53. 53.

    Yomo S, Carron R, Thomassin JM, Roche PH, Régis J (2012) Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma. Clinical article. J Neurosurg 117:877–885

  54. 54.

    Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC (2007) Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 68:845–851

  55. 55.

    Régis J, Roche PH, Delsanti C, Thomassin JM, Ouaknine M, Gabert K, Pellet W (2007) Modern management of vestibular schwannomas. Prog Neurol Surg 20:129–141

  56. 56.

    Kim CH, Chung KW, Kong DS, Nam DH, Park K, Kim JH, Hong SH, Cho YS, Chung WH, Lee JI (2010) Prognostic factors of hearing preservation after gamma knife radiosurgery for vestibular schwannoma. J Clin Neurosci 17:214–218

  57. 57.

    Persson O, Bartek J Jr, Shalom NB, Wangerid T, Jakola AS, Förander P (2017) Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir 159:1013–1021

  58. 58.

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

  59. 59.

    Régis J, Carron R, Park MC, Soumare O, Delsanti C, Thomassin JM, Roche PH (2010) Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 113(Suppl):105–111

  60. 60.

    Hirsch A, Norén G, Anderson H (1979) Audiologic findings after stereotactic radiosurgery in nine cases of acoustic neurinomas. Acta Otolaryngol 88:155–160

  61. 61.

    North HJD, Lloyd SKW (2018) Hearing rehabilitation in neurofibromatosis type 2. Adv Otorhinolaryngol. Basel, Karger 81:93–104

  62. 62.

    Lloyd SK, Glynn FJ, Rutherford SA, King AT, Mawman DJ, O’Driscoll MP et al (2014) Ipsilateral cochlear implantation after cochlear nerve preserving vestibular schwannoma surgery in patients with neurofibromatosis type 2. Otol Neurotol 35:43–51

  63. 63.

    North HJ, Mawman D, O’Driscoll M, Freeman SR, Rutherford SA, King AT, Hammerbeck-Ward C, Evans DG, Lloyd SK (2016) Outcomes of cochlear implantation in patients with neurofibromatosis type 2. Cochlear Implants Int 17:172–177

  64. 64.

    Vincenti V, Pasanisi E, Guida M, Di Trapani G, Sanna M (2008) Hearing rehabilitation in neurofibromatosis type 2 patients: cochlear versus auditory brainstem implantation. Audiol Neurootol 13:273–280

  65. 65.

    Graham J, Lynch C, Weber B, Stollwerck L, Wei J, Brookes G (1999) The magnetless Clarion cochlear implant in a patient with neurofibromatosis 2. J Laryngol Otol 113:458–463

  66. 66.

    Nölle C, Todt I, Basta D, Unterberg A, Mautner VF, Ernst A (2003) Cochlear implantation after acoustic tumour resection in neurofibromatosis type 2: impact of intra- and postoperative neural response telemetry monitoring. ORL J Otorhinolaryngol Relat Spec 65:230–234

  67. 67.

    Neff BA, Wiet RM, Lasak JM, Cohen NL, Pillsbury HC, Ramsden RT, Welling DB (2007) Cochlear implantation in the neurofibromatosis type 2 patient: long-term follow-up. Laryngoscope 117:1069–1072

  68. 68.

    Arístegui M, Denia A (2005) Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of 2 cases (neurofibromatosis type 2 and unilateral vestibular schwannoma). Otol Neurotol 26:205–210

  69. 69.

    Hoffman RA, Kohan D, Cohen NL (1992) Cochlear implants in the management of bilateral acoustic neuromas. Am J Otolaryngol 13:525–528

  70. 70.

    Celis-Aguilar E, Lassaletta L, Gavilán J (2012) Cochlear implantation in patients with neurofibromatosis type 2 and patients with vestibular schwannoma in the only hearing ear. Int J Otolaryngol 2012:157497

  71. 71.

    Jia H, El Sayed MME, Smail M, Mosnier I, Wu H, Sterkers O, Kalamarides M, Bernardeschi D (2018) Neurofibromatosis type 2: hearing preservation and rehabilitation. Neurochirurgie. 64(5):348–354

  72. 72.

    Douglas SA, Yeung P, Daudia A, Gatehouse S, O’Donoghue GM (2007) Spatial hearing disability after acoustic neuroma removal. Laryngoscope 117(9):1648–1651

  73. 73.

    Kecskeéti N, Szőnyi M, Küstel M, Gáborján A, Tamás L, Répássy G (2019) Cochlear implantation under local anesthesia: a possible alternative for elderly patients. Eur Arch Otorhinolaryngol 276(6):1643–1647

  74. 74.

    Harford E, Dodds E (1996) The clinical application of CROS: a hearing aid for unilateral deafness. Arch Otolaryngol 83(5):455–464

  75. 75.

    Hol MK, Kunst SJ, Snik AF, Bosman AJ, Mylanus EA, Cremers CW (2010) Bone-anchored hearing aids in patients with acquired and congenital unilateral inner ear deafness (Baha CROS): clinical evaluation of 56 cases. Ann Otol Rhinol Laryngol 119(7):447–454

  76. 76.

    Arndt S, Aschendorff A, Laszig R, Beck R, Schild C, Kroeger S, Ihorst G, Wesarg T (2011) Comparison of pseudo binaural hearing to real binaural hearing rehabilitation after cochlear implantation in patients with unilateral deafness and tinnitus. Otol Neurotol 32(1):39–47

  77. 77.

    Funes CJ, Mace RA, Macklin EA, Plotkin SR, Jordan JT, Vranceanu AM (2019) First report of quality of life in adults with neurofibromatosis 2 who are deafened or have significant hearing loss: results of a live-video randomized control trial. J Neuro-Oncol 143(3):505–513

  78. 78.

    Zanoletti E, Mazzoni A, d’Avella D (2019) Hearing preservation in small acoustic neuroma: observation or active therapy? Literature review and institutional experience. Acta Neurochir 161(1):79–83

  79. 79.

    Walton J, Donnelly NP, Tam YC, Joubert I, Durie-Gair J, Jackson C, Mannion RA, Tysome JR, Axon PR, Scoffings DJ (2014) MRI without magnet removal in neurofibromatosis type 2 patients with cochlear and auditory brainstem implants. Otol Neurotol 35(5):821–825

  80. 80.

    Todt I, Tittel A, Ernst A, Mittmann P, Mutze S (2017) Pain free 3 T MRI scans in cochlear implantees. Otol Neurotol 38(10):e401–e404

  81. 81.

    Carlson ML, Neff BA, Link MJ, Lane JI, Watson RE, McGee KP, Bernstein MA, Driscoll CL (2015) Magnetic resonance imaging with cochlear implant magnet in place: safety and imaging quality. Otol Neurotol 36(6):965–971

  82. 82.

    Sharon JD, Northcutt BG, Aygun N, Francis HW (2016) Magnetic resonance imaging a 1.5 Tesla with a cochlear implant magnet in place: image quality and usability. Otol Neurotol 37:1284–1290

Download references

Author information

Correspondence to Carlotta Morselli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research is based on review of published/publicly reported literature. Therefore this research does not require ethics approval.

Informed consent

Not necessary.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Morselli, C., Boari, N., Artico, M. et al. The emerging role of hearing loss rehabilitation in patients with vestibular schwannoma treated with Gamma Knife radiosurgery: literature review. Neurosurg Rev (2020). https://doi.org/10.1007/s10143-020-01257-8

Download citation

Keywords

  • Vestibular schwannoma
  • Hearing loss
  • Stereotactic radiosurgery
  • Gamma Knife
  • Cochlear implant
  • Hearing restoration