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



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.


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.


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).


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.



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.


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.


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).


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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Fig. 1
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Fig. 4



Three-dimensional constructive interference in steady state


Cerebellopontine angle


Cerebrospinal fluid




Fluid-attenuated inversion recovery


Field of view




Internal auditory canal


Large vestibular aqueduct syndrome


Multiplanar reconstruction


Pure-tone audiometry


Stereotactic radiosurgery


Slice thickness


Echo time


Repetition time


Vestibular schwannoma


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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.

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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).

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  • 3D-CISS
  • Labyrinth signal loss
  • Magnetic resonance imaging
  • Vestibular schwannoma
  • Radiosurgery


  • 3‑D-CISS
  • Signalverlust Labyrinth
  • Magnetresonanztomographie
  • Vestibularisschwannom
  • Radiochirurgie