Hearing Outcomes After Stereotactic Radiosurgery for Vestibular Schwannomas

Mechanism of Hearing Loss and How to Preserve Hearing
  • Jung Ho Han
  • Dong Gyu KimEmail author
  • Hyun-Tai Chung
  • Sun Ha Paek
  • Hee-Won Jung
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 43)


The use of stereotactic radiosurgery (SRS) expanded to include the treatment of vestibular schwannomas (VSs) in 1969; since then, efforts to increase tumour control and to reduce cranial neuropathy have continued. Using the currently recommended marginal dose of 12–13 Gy, long-term reported outcomes after SRS include not only excellent tumour control rates of 92–100 % but also outstanding functional preservation of the trigeminal and facial nerves, with values of 92–100 % and 94–100 %, respectively. Nonetheless, hearing preservation remains in the range of 32–81 %. Previous studies have suggested possible prognostic factors of hearing preservation such as the Gardner-Robertson grade, radiation dose to the cochlea, transient volume expansion (TVE) after SRS, length of irradiated cochlear nerve, marginal dose to the tumour, and age. However, we still do not clearly understand why patients lose their hearing after SRS for VS.

Relevant to these considerations, one study recently reported that the auditory brainstem response (ABR) wave V latency and waves I and V interval (IL_I–V) correlated well with intracanalicular pressure values and even with hearing level. The demonstration that ABR values, especially wave V latency and IL_I–V, correlate well with intracanalicular pressure suggests that patients with previously elevated intracanalicular pressure might have an increased chance of hearing loss on development of TVE, which has been recognised as a common phenomenon after SRS or stereotactic radiotherapy (SRT) for intracranial schwannomas.

In our experience, the ABR IL_I–V increased during the first 12 months after SRS for VSs in patients who lost their serviceable hearing. The effect of increased ABR IL_I–V on hearing outcome also became significant over time, especially at 12 months after SRS, and was more prominent in patients with poor initial pure-tone average (PTA) and/or ABR values. We hypothesise that patients with considerable intracanalicular pressure at the time of SRS are prone to lose their serviceable hearing due to the added intracanalicular pressure induced by TVE, which usually occurs within the first 12 months after SRS for VSs. Using these findings, we suggested a classification system for the prediction of hearing outcomes after SRS for VSs. This classification system could be useful in the proper selection of management modalities for hearing preservation, especially in patients with only hearing ear schwannoma or neurofibromatosis type 2.

Advances in diagnostic tools, treatment modalities, and optimisation of radiosurgical dose have improved clinical outcomes, including tumour control and cranial neuropathies, in patients with VSs. However, the preservation of hearing function still falls short of our expectation. A prediction model for hearing preservation after each treatment modality will guide the proper selection of treatment modalities and permit the appropriate timing of active treatment, which will lead to the preservation of hearing function in patients with VSs.


Stereotactic radiosurgery Vestibular schwannoma Hearing preservation Intracanalicular pressure Transient volume expansion Auditory brainstem response 


  1. 1.
    Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC (1995) Otolaryngol Head Neck Surg 113:179–180Google Scholar
  2. 2.
    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 13:124–127PubMedCrossRefGoogle Scholar
  3. 3.
    Aoyama H, Onodera S, Takeichi N, Onimaru R, Terasaka S, Sawamura Y, Shirato H (2013) Symptomatic outcomes in relation to tumor expansion after fractionated stereotactic radiation therapy for vestibular schwannomas: single-institutional long-term experience. Int J Radiat Oncol Biol Phys 85:329–334PubMedCrossRefGoogle Scholar
  4. 4.
    Aronzon A, Ruckenstein MJ, Bigelow DC (2003) The efficacy of corticosteroids in restoring hearing in patients undergoing conservative management of acoustic neuromas. Otol Neurotol 24:465–468PubMedCrossRefGoogle Scholar
  5. 5.
    Asthagiri AR, Vasquez RA, Butman JA, Wu T, Morgan K, Brewer CC, King K, Zalewski C, Kim HJ, Lonser RR (2012) Mechanisms of hearing loss in neurofibromatosis type 2. PLoS One 7, e46132PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Badie B, Pyle GM, Nguyen PH, Hadar EJ (2001) Elevation of internal auditory canal pressure by vestibular schwannomas. Otol Neurotol 22:696–700PubMedCrossRefGoogle Scholar
  7. 7.
    Bae SC, Noh HI, Jun BC, Jeon EJ, Seo JH, Park SY, Kim JK, Lee DH, Oh JH, Park SN, Yeo SW (2013) Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy. Acta Otolaryngol 133:428–433PubMedCrossRefGoogle Scholar
  8. 8.
    Bakkouri WE, Kania RE, Guichard JP, Lot G, Herman P, Huy PT (2009) Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 110:662–669PubMedCrossRefGoogle Scholar
  9. 9.
    Baschnagel AM, Chen PY, Bojrab D, Pieper D, Kartush J, Didyuk O, Naumann IC, Maitz A, Grills IS (2013) Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 118:571–578PubMedCrossRefGoogle Scholar
  10. 10.
    Brackmann DE, Owens RM, Friedman RA, Hitselberger WE, De la Cruz A, House JW, Nelson RA, Luxford WM, Slattery WH 3rd, Fayad JN (2000) Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol 21:417–424PubMedCrossRefGoogle Scholar
  11. 11.
    Brada M (2013) Radiotherapy for benign brain tumours coming of age; example of vestibular schwannoma. Radiother Oncol 106:157–160PubMedCrossRefGoogle Scholar
  12. 12.
    Bradley Lega JS, Michael Ruckinstein, Douglas Bigelow, Jay Dorsey, Michele Alonso-Basanta, John YK Lee (2012) Cochlear radiation dose does not predict hearing loss after gamma knife for glomus jugulare tumors. The 16th International Leksell Gamma Knife Society meeting SydneyGoogle Scholar
  13. 13.
    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 33:853–862PubMedCrossRefGoogle Scholar
  14. 14.
    Carlson ML, Jacob JT, Pollock BE, Neff BA, Tombers NM, Driscoll CL, Link MJ (2013) Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 118:579–587PubMedCrossRefGoogle Scholar
  15. 15.
    Celis-Aguilar E, Lassaletta L, Gavilan J (2012) Cochlear implantation in patients with neurofibromatosis type 2 and patients with vestibular schwannoma in the only hearing ear. Int J Otolaryngol 2012:157497PubMedCentralPubMedGoogle Scholar
  16. 16.
    Chen CH, Shen CC, Sun MH, Ho WL, Huang CF, Kwan PC (2007) Histopathology of radiation necrosis with severe peritumoral edema after gamma knife radiosurgery for parasagittal meningioma. A report of two cases. Stereotact Funct Neurosurg 85:292–295PubMedCrossRefGoogle Scholar
  17. 17.
    Chinn J, Miller J (1975) Animal model acoustic neuroma. Arch Otolaryngol 101:222–226PubMedCrossRefGoogle Scholar
  18. 18.
    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 68:845–851PubMedCrossRefGoogle Scholar
  19. 19.
    Chuang CC, Chang CS, Tyan YS, Chuang KS, Tu HT, Huang CF (2012) Use of apparent diffusion coefficients in evaluating the response of vestibular schwannomas to Gamma Knife surgery. J Neurosurg 117(Suppl):63–68PubMedGoogle Scholar
  20. 20.
    Chung WY, Liu KD, Shiau CY, Wu HM, Wang LW, Guo WY, Ho DM, Pan DH (2005) Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 102(Suppl):87–96PubMedCrossRefGoogle Scholar
  21. 21.
    Colletti L, Shannon R, Colletti V (2012) Auditory brainstem implants for neurofibromatosis type 2. Curr Opin Otolaryngol Head Neck Surg 20:353–357PubMedCrossRefGoogle Scholar
  22. 22.
    Combs SE, Thilmann C, Debus J, Schulz-Ertner D (2006) Long-term outcome of stereotactic radiosurgery (SRS) in patients with acoustic neuromas. Int J Radiat Oncol Biol Phys 64:1341–1347PubMedCrossRefGoogle Scholar
  23. 23.
    Combs SE, Welzel T, Kessel K, Habermehl D, Rieken S, Schramm O, Debus J (2013) 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 106:175–180PubMedCrossRefGoogle Scholar
  24. 24.
    Dandy WE (1925) An operation for the total removal of cerebellopontine (acoustic) tumors. Surg Gynecol Obstet 41:129–148Google Scholar
  25. 25.
    Eminowicz GK, Raman R, Conibear J, Plowman PN (2012) Bevacizumab treatment for vestibular schwannomas in neurofibromatosis type two: report of two cases, including responses after prior gamma knife and vascular endothelial growth factor inhibition therapy. J Laryngol Otol 126:79–82PubMedCrossRefGoogle Scholar
  26. 26.
    Faber HT, de Wolf MJ, Cremers CW, Snik AF, Hol MK (2013) Benefit of Baha in the elderly with single-sided deafness. Eur Arch Otorhinolaryngol 270:1285–1291PubMedCrossRefGoogle Scholar
  27. 27.
    Ferri GG, Modugno GC, Pirodda A, Fioravanti A, Calbucci F, Ceroni AR (2008) Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope 118:951–957PubMedCrossRefGoogle Scholar
  28. 28.
    Flickinger JC (2001) Cranial nerves. In: Shrieve DC (ed) Human radiation injury. Lippincott Williams & Wilkins, a Wolters Kluwer business, PhiladelphiaGoogle Scholar
  29. 29.
    Fong BM, Pezeshkian P, Nagasawa DT, De Salles A, Gopen Q, Yang I (2012) Hearing preservation after LINAC radiosurgery and LINAC radiotherapy for vestibular schwannoma. J Clin Neurosci 19:1065–1070PubMedCrossRefGoogle Scholar
  30. 30.
    Fowler JF (1989) The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62:679–694PubMedCrossRefGoogle Scholar
  31. 31.
    Gadre AK, Kwartler JA, Brackmann DE, House WF, Hitselberger WE (1990) Middle fossa decompression of the internal auditory canal in acoustic neuroma surgery: a therapeutic alternative. Laryngoscope 100:948–952PubMedCrossRefGoogle Scholar
  32. 32.
    Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66PubMedCrossRefGoogle Scholar
  33. 33.
    Gerosa M, Mesiano N, Longhi M, De Simone A, Foroni R, Verlicchi A, Zanotti B, Nicolato A (2010) Gamma Knife surgery in vestibular schwannomas: impact on the anterior and posterior labyrinth. J Neurosurg 113(Suppl):128–135PubMedGoogle Scholar
  34. 34.
    Givre A, Olivecrona H (1949) Surgical experiences with acoustic tumors. J Neurosurg 6:396–407PubMedCrossRefGoogle Scholar
  35. 35.
    Godefroy WP, Kaptein AA, Vogel JJ, van der Mey AG (2009) Conservative treatment of vestibular schwannoma: a follow-up study on clinical and quality-of-life outcome. Otol Neurotol 30:968–974PubMedCrossRefGoogle Scholar
  36. 36.
    Grayeli AB, Kalamarides M, Ferrary E, Bouccara D, Elgharem H, Rey A, Sterkers O (2005) Conservative management versus surgery for small vestibular schwannomas. Acta Otolaryngol 125:1063–1068CrossRefGoogle Scholar
  37. 37.
    Greiman MC, Lusk RP (1991) Pressure-induced modifications of the acoustic nerve. Part II: Auditory brain stem responses. Am J Otolaryngol 12:12–19PubMedCrossRefGoogle Scholar
  38. 38.
    Hajioff D, Raut VV, Walsh RM, Bath AP, Bance ML, Guha A, Tator CH, Rutka JA (2008) Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 33:255–259PubMedCrossRefGoogle Scholar
  39. 39.
    Han JH, Kim DG, Chung HT, Paek SH, Kim YH, Kim CY, Kim JW, Kim YH, Jeong SS (2009) Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia. Int J Radiat Oncol Biol Phys 75:822–827PubMedCrossRefGoogle Scholar
  40. 40.
    Han JH, Kim DG, Chung HT, Paek SH, Park CK, Kim CY, Hwang SS, Park JH, Kim YH, Kim JW, Kim YH, Song SW, Kim IK, Jung HW (2012) The risk factors of symptomatic communicating hydrocephalus after stereotactic radiosurgery for unilateral vestibular schwannoma: the implication of brain atrophy. Int J Radiat Oncol Biol Phys 84:937–942PubMedCrossRefGoogle Scholar
  41. 41.
    Han JH, Kim DG, Chung HT, Paek SH, Park CK, Kim CY, Kim YH, Kim JW, Kim YH, Song SW, Kim IK, Jung HW (2012) Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery: reinterpretation of the auditory brainstem response. Cancer 118:5441–5447PubMedCrossRefGoogle Scholar
  42. 42.
    Handzel O, Ben-Ari O, Damian D, Priel MM, Cohen J, Himmelfarb M (2013) Smartphone-based hearing test as an aid in the initial evaluation of unilateral sudden sensorineural hearing loss. Audiol Neurootol 18:201–207PubMedCrossRefGoogle Scholar
  43. 43.
    Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557–565PubMedCrossRefGoogle Scholar
  44. 44.
    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 115:1078–1086PubMedCrossRefGoogle Scholar
  45. 45.
    Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J (2005) Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up. J Neurosurg 102:10–16PubMedCrossRefGoogle Scholar
  46. 46.
    Hasegawa T, Kida Y, Yoshimoto M, Koike J, Goto K (2006) Evaluation of tumor expansion after stereotactic radiosurgery in patients harboring vestibular schwannomas. Neurosurgery 58:1119–1128; discussion 1119–1128PubMedCrossRefGoogle Scholar
  47. 47.
    Hietanen A, Era P, Sorri M, Heikkinen E (2004) Changes in hearing in 80-year-old people: a 10-year follow-up study. Int J Audiol 43:126–135PubMedCrossRefGoogle Scholar
  48. 48.
    Huang E, Strother DR, Davis QG, Chiu JK, Lu HH, Carpenter LS, Mai WY, Chintagumpala MM, South M, Grant WH, Butler EB, Woo SY (2002) Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity. Int J Radiat Oncol Biol Phys 52:599–605PubMedCrossRefGoogle Scholar
  49. 49.
    Iwai Y, Yamanaka K, Kubo T, Aiba T (2008) Gamma knife radiosurgery for intracanalicular acoustic neuromas. J Clin Neurosci 15:993–997PubMedCrossRefGoogle Scholar
  50. 50.
    Iwai Y, Yamanaka K, Shiotani M, Uyama T (2003) Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282–287; discussion 287–288PubMedCrossRefGoogle Scholar
  51. 51.
    Iwai Y, Yamanaka K, Yamagata K, Yasui T (2007) Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings. Neurosurgery 60:ONS75–ONS82; discussion ONS82PubMedGoogle Scholar
  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 111:863–873PubMedCrossRefGoogle Scholar
  53. 53.
    Kapoor S, Batra S, Carson K, Shuck J, Kharkar S, Gandhi R, Jackson J, Wemmer J, Terezakis S, Shokek O, Kleinberg L, Rigamonti D (2011) Long-term outcomes of vestibular schwannomas treated with fractionated stereotactic radiotherapy: an institutional experience. Int J Radiat Oncol Biol Phys 81:647–653PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Kari E, Friedman RA (2012) Hearing preservation: microsurgery. Curr Opin Otolaryngol Head Neck Surg 20:358–366PubMedCrossRefGoogle Scholar
  55. 55.
    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 17:214–218PubMedCrossRefGoogle Scholar
  56. 56.
    Kim JW, Kim DG, Paek SH, Chung HT, Kim YH, Han JH, Park CK, Jung HW (2011) Efficacy of corticosteroids in hearing preservation after radiosurgery for vestibular schwannoma: a prospective study. Stereotact Funct Neurosurg 89:25–33PubMedCrossRefGoogle Scholar
  57. 57.
    Kim KM, Park CK, Chung HT, Paek SH, Jung HW, Kim DG (2007) Long-term outcomes of gamma knife stereotactic radiosurgery of vestibular schwannomas. J Korean Neurosurg Soc 42:286–292PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, Park JH, Kim JW, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2012) Radiosurgery for para-IAC meningiomas: the effect of radiation dose to the cochlea on hearing outcome. Int J Radiat Oncol Biol Phys 84:675–680PubMedCrossRefGoogle Scholar
  59. 59.
    Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, Park JH, Kim JW, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2013) Hearing outcomes after stereotactic radiosurgery for unilateral intracanalicular vestibular schwannomas: implication of transient volume expansion. Int J Radiat Oncol Biol Phys 85:61–67PubMedCrossRefGoogle Scholar
  60. 60.
    Landi A, Marina R, DeGrandi C, Crespi A, Montanari G, Sganzerla EP, Gaini SM (2001) Accuracy of stereotactic localisation with magnetic resonance compared to CT scan: experimental findings. Acta Neurochir (Wien) 143:593–601CrossRefGoogle Scholar
  61. 61.
    Lapsiwala SB, Pyle GM, Kaemmerle AW, Sasse FJ, Badie B (2002) Correlation between auditory function and internal auditory canal pressure in patients with vestibular schwannomas. J Neurosurg 96:872–876PubMedCrossRefGoogle Scholar
  62. 62.
    Lee SR, Yang KA, Kim SK, Kim SH (2012) Radiation-induced intratumoral necrosis and peritumoral edema after gamma knife radiosurgery for intracranial meningiomas. J Korean Neurosurg Soc 52:98–102PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316–319PubMedGoogle Scholar
  64. 64.
    Leksell L (1971) A note on the treatment of acoustic tumours. Acta Chir Scand 137:763–765PubMedGoogle Scholar
  65. 65.
    Lin LM, Bowditch S, Anderson MJ, May B, Cox KM, Niparko JK (2006) Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification. Otol Neurotol 27:172–182PubMedCrossRefGoogle Scholar
  66. 66.
    Linskey ME (2000) Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate. J Neurosurg 93(Suppl 3):90–95PubMedGoogle Scholar
  67. 67.
    Linskey ME (2008) Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters? J Neurosurg 109(Suppl):129–136PubMedGoogle Scholar
  68. 68.
    Linthicum FH Jr, Brackmann DE (1980) Bilateral acoustic tumors. A diagnostic and surgical challenge. Arch Otolaryngol 106:729–733PubMedCrossRefGoogle Scholar
  69. 69.
    Litre F, Rousseaux P, Jovenin N, Bazin A, Peruzzi P, Wdowczyk D, Colin P (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: a prospective monocenter study of about 158 cases. Radiother Oncol 106:169–174PubMedCrossRefGoogle Scholar
  70. 70.
    Lunsford LD, Kondziolka D, Maitz A, Flickinger JC (1998) Black holes, white dwarfs and supernovas: imaging after radiosurgery. Stereotact Funct Neurosurg 70(Suppl 1):2–10PubMedCrossRefGoogle Scholar
  71. 71.
    Lustig LR, Yeagle J, Driscoll CL, Blevins N, Francis H, Niparko JK (2006) Cochlear implantation in patients with neurofibromatosis type 2 and bilateral vestibular schwannoma. Otol Neurotol 27:512–518PubMedCrossRefGoogle Scholar
  72. 72.
    Ma L, Sahgal A, Descovich M, Cho YB, Chuang C, Huang K, Laperriere NJ, Shrieve DC, Larson DA (2010) Equivalence in dose fall-off for isocentric and nonisocentric intracranial treatment modalities and its impact on dose fractionation schemes. Int J Radiat Oncol Biol Phys 76:943–948PubMedCrossRefGoogle Scholar
  73. 73.
    Malhotra PS, Sharma P, Fishman MA, Grumbine FL, Tholey R, Dam VQ, Dasgupta A, Pequignot E, Willcox TO (2009) Clinical, radiographic, and audiometric predictors in conservative management of vestibular schwannoma. Otol Neurotol 30:507–514PubMedCrossRefGoogle Scholar
  74. 74.
    Mandl ES, Meijer OW, Slotman BJ, Vandertop WP, Peerdeman SM (2010) Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 95:94–98PubMedCrossRefGoogle Scholar
  75. 75.
    Maniakas A, Saliba I (2012) Conservative management versus stereotactic radiation for vestibular schwannomas: a meta-analysis of patients with more than 5 years’ follow-up. Otol Neurotol 33:230–238PubMedCrossRefGoogle Scholar
  76. 76.
    Maniakas A, Saliba I (2012) Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years’ follow-up. Otol Neurotol 33:1611–1620PubMedCrossRefGoogle Scholar
  77. 77.
    Massager N, Nissim O, Delbrouck C, Delpierre I, Devriendt D, Desmedt F, Wikler D, Brotchi J, Levivier M (2007) Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 107:733–739PubMedCrossRefGoogle Scholar
  78. 78.
    Massager N, Nissim O, Delbrouck C, Devriendt D, David P, Desmedt F, Wikler D, Hassid S, Brotchi J, Levivier M (2006) Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. Int J Radiat Oncol Biol Phys 64:1331–1340PubMedCrossRefGoogle Scholar
  79. 79.
    Merkus P, Lella FD, Trapani GD, Pasanisi E, Beltrame MA, Zanetti D, Negri M, Sanna M (2014) Indications and contraindications of auditory brainstem implants: systematic review and illustrative cases. Eur Arch Otorhinolaryngol 271:3–13PubMedCrossRefGoogle Scholar
  80. 80.
    Nagano O, Higuchi Y, Serizawa T, Ono J, Matsuda S, Yamakami I, Saeki N (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109:811–816PubMedCrossRefGoogle Scholar
  81. 81.
    Niranjan A, Mathieu D, Flickinger JC, Kondziolka D, Lunsford LD (2008) Hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Neurosurgery 63:1054–1062; discussion 1062–1053PubMedCrossRefGoogle Scholar
  82. 82.
    Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, McElveen JT Jr, Cunningham CD 3rd, Zomorodi AR (2013) Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery 72:ons103–ons115; discussion ons115PubMedGoogle Scholar
  83. 83.
    Northfield DW (1970) Surgical treatment of acoustic neurinoma. The conventional approach. Proc R Soc Med 63:769–775PubMedCentralPubMedGoogle Scholar
  84. 84.
    Noudel R, Gomis P, Duntze J, Marnet D, Bazin A, Roche PH (2009) Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches. Acta Neurochir (Wien) 151:935–944; discussion 944–935CrossRefGoogle Scholar
  85. 85.
    Odat HA, Piccirillo E, Sequino G, Taibah A, Sanna M (2011) Management strategy of vestibular schwannoma in neurofibromatosis type 2. Otol Neurotol 32:1163–1170PubMedCrossRefGoogle Scholar
  86. 86.
    Paek SH, Chung HT, Jeong SS, Park CK, Kim CY, Kim JE, Kim DG, Jung HW (2005) Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 104:580–590PubMedCrossRefGoogle Scholar
  87. 87.
    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 123:2019–2023PubMedCrossRefGoogle Scholar
  88. 88.
    Pennybacker JB, Cairns H (1950) Results in 130 cases of acoustic neurinoma. J Neurol Neurosurg Psychiatry 13:272–277PubMedCentralPubMedCrossRefGoogle Scholar
  89. 89.
    Phi JH, Paek SH, Chung HT, Jeong SS, Park CK, Jung HW, Kim DG (2007) Gamma Knife surgery and trigeminal schwannoma: is it possible to preserve cranial nerve function? J Neurosurg 107:727–732PubMedCrossRefGoogle Scholar
  90. 90.
    Plotkin SR, Stemmer-Rachamimov AO, Barker FG 2nd, 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 361:358–367PubMedCrossRefGoogle Scholar
  91. 91.
    Pollock BE (2006) Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 58:241–248; discussion 241–248PubMedCrossRefGoogle Scholar
  92. 92.
    Pollock BE, Link MJ, Foote RL (2009) Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma. J Neurosurg 111:840–844PubMedCrossRefGoogle Scholar
  93. 93.
    Ramsden RT (1995) The bloody angle: 100 years of acoustic neuroma surgery. J R Soc Med 88:464–468Google Scholar
  94. 94.
    Raut VV, Walsh RM, Bath AP, Bance ML, Guha A, Tator CH, Rutka JA (2004) Conservative management of vestibular schwannomas – second review of a prospective longitudinal study. Clin Otolaryngol Allied Sci 29:505–514PubMedCrossRefGoogle Scholar
  95. 95.
    Rosenberg SI (2000) Natural history of acoustic neuromas. Laryngoscope 110:497–508PubMedCrossRefGoogle Scholar
  96. 96.
    Sakamoto T, Shirato H, Takeichi N, Aoyama H, Kagei K, Nishioka T, Fukuda S (2001) Medication for hearing loss after fractionated stereotactic radiotherapy (SRT) for vestibular schwannoma. Int J Radiat Oncol Biol Phys 50:1295–1298PubMedCrossRefGoogle Scholar
  97. 97.
    Samii M (1995) Hearing preservation in bilateral acoustic neurinomas. Br J Neurosurg 9:413–424PubMedCrossRefGoogle Scholar
  98. 98.
    Samii M, Gerganov V, Samii A (2008) Hearing preservation after complete microsurgical removal in vestibular schwannomas. Prog Neurol Surg 21:136–141PubMedCrossRefGoogle Scholar
  99. 99.
    Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40:248–260; discussion 260–242PubMedCrossRefGoogle Scholar
  100. 100.
    Samii M, Matthies C, Tatagiba M (1997) Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. Neurosurgery 40:696–705; discussion 705–696PubMedCrossRefGoogle Scholar
  101. 101.
    Sanna M, Di Lella F, Guida M, Merkus P (2012) Auditory brainstem implants in NF2 patients: results and review of the literature. Otol Neurotol 33:154–164PubMedCrossRefGoogle Scholar
  102. 102.
    Slattery WH, Hoa M, Bonne N, Friedman RA, Schwartz MS, Fisher LM, Brackmann DE (2011) Middle fossa decompression for hearing preservation: a review of institutional results and indications. Otol Neurotol 32:1017–1024PubMedCrossRefGoogle Scholar
  103. 103.
    Stangerup SE, Caye-Thomasen P (2012) Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 45(257–268):viiGoogle Scholar
  104. 104.
    Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J (2008) Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma. J Laryngol Otol 122:673–681PubMedCrossRefGoogle Scholar
  105. 105.
    Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Yang I, Pitts LH, Tihan T, Parsa AT (2011) Intratumoral hemorrhage and fibrosis in vestibular schwannoma: a possible mechanism for hearing loss. J Neurosurg 114:386–393PubMedCrossRefGoogle Scholar
  106. 106.
    Sughrue ME, Yang I, Aranda D, Lobo K, Pitts LH, Cheung SW, Parsa AT (2010) The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 112:163–167PubMedCrossRefGoogle Scholar
  107. 107.
    Szeifert GT, Figarella-Branger D, Roche PH, Regis J (2004) Histopathological observations on vestibular schwannomas after Gamma Knife radiosurgery: the Marseille experience. Neurochirurgie 50:327–337PubMedGoogle Scholar
  108. 108.
    Thomas C, Di Maio S, Ma R, Vollans E, Chu C, Math M, Clark B, Lee R, McKenzie M, Martin M, Toyota B (2007) Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose. J Neurosurg 107:917–926PubMedCrossRefGoogle Scholar
  109. 109.
    Timmer FC, Hanssens PE, van Haren AE, Mulder JJ, Cremers CW, Beynon AJ, van Overbeeke JJ, Graamans K (2009) Gamma knife radiosurgery for vestibular schwannomas: results of hearing preservation in relation to the cochlear radiation dose. Laryngoscope 119:1076–1081PubMedCrossRefGoogle Scholar
  110. 110.
    Trotter MI, Briggs RJ (2010) Cochlear implantation in neurofibromatosis type 2 after radiation therapy. Otol Neurotol 31:216–219PubMedCrossRefGoogle Scholar
  111. 111.
    van de Langenberg R, Dohmen AJ, de Bondt BJ, Nelemans PJ, Baumert BG, Stokroos RJ (2012) Volume changes after stereotactic LINAC radiotherapy in vestibular schwannoma: control rate and growth patterns. Int J Radiat Oncol Biol Phys 84:343–349PubMedCrossRefGoogle Scholar
  112. 112.
    van Eck AT, Horstmann GA (2005) Increased preservation of functional hearing after gamma knife surgery for vestibular schwannoma. J Neurosurg 102(Suppl):204–206PubMedGoogle Scholar
  113. 113.
    Varughese JK, Wentzel-Larsen T, Vassbotn F, Moen G, Lund-Johansen M (2010) Analysis of vestibular schwannoma size in multiple dimensions: a comparative cohort study of different measurement techniques. Clin Otolaryngol 35:97–103PubMedCrossRefGoogle Scholar
  114. 114.
    Vokurka EA, Herwadkar A, Thacker NA, Ramsden RT, Jackson A (2002) Using Bayesian tissue classification to improve the accuracy of vestibular schwannoma volume and growth measurement. AJNR Am J Neuroradiol 23:459–467PubMedGoogle Scholar
  115. 115.
    Wanibuchi M, Fukushima T, Friedman AH, Watanabe K, Akiyama Y, Mikami T, Iihoshi S, Murakami T, Sugino T, Mikuni N (2014) Hearing preservation surgery for vestibular schwannomas via the retrosigmoid transmeatal approach: surgical tips. Neurosurg Rev 37:431–444PubMedCrossRefGoogle Scholar
  116. 116.
    Wazen JJ, Spitzer JB, Ghossaini SN, Fayad JN, Niparko JK, Cox K, Brackmann DE, Soli SD (2003) Transcranial contralateral cochlear stimulation in unilateral deafness. Otolaryngol Head Neck Surg 129:248–254PubMedCrossRefGoogle Scholar
  117. 117.
    Wei BP, Stathopoulos D, O’Leary S (2013) Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev 7:CD003998Google Scholar
  118. 118.
    Whitehouse K, Foroughi M, Shone G, Hatfield R (2010) Vestibular schwannomas – when should conservative management be reconsidered? Br J Neurosurg 24:185–190PubMedCrossRefGoogle Scholar
  119. 119.
    Wong HK, Lahdenranta J, Kamoun WS, Chan AW, McClatchey AI, Plotkin SR, Jain RK, di Tomaso E (2010) Anti-vascular endothelial growth factor therapies as a novel therapeutic approach to treating neurofibromatosis-related tumors. Cancer Res 70:3483–3493PubMedCrossRefGoogle Scholar
  120. 120.
    Wowra B, Muacevic A, Jess-Hempen A, Hempel JM, Muller-Schunk S, Tonn JC (2005) Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience. J Neurosurg 102(Suppl):114–118PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jung Ho Han
    • 1
    • 2
  • Dong Gyu Kim
    • 1
    • 3
    Email author
  • Hyun-Tai Chung
    • 1
    • 3
  • Sun Ha Paek
    • 1
    • 3
  • Hee-Won Jung
    • 1
    • 3
  1. 1.Department of NeurosurgerySeoul National University College of MedicineSeoulKorea
  2. 2.Department of NeurosurgerySeoul National University Bundang HospitalGyeonggi-doKorea
  3. 3.Department of NeurosurgerySeoul National University HospitalSeoulKorea

Personalised recommendations