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Neuro-otological Findings After Radiosurgery for Acoustic Neurinomas

Neuro-otological Findings After Radiosurgery for Acoustic Neurinomas Abstract Objective: To evaluate the neuro-otological complications in patients after radiosurgery for acoustic neurinomas. Design: Inception cohort, retrospective study. Setting: University hospital. Patients: A consecutive sample of 46 patients with acoustic neurinomas who underwent unilateral gamma knife radiosurgery at the University of Tokyo, Japan, between June 1990 and June 1994 were followed up by otolaryngologists for more than 3 months. Intervention: Gamma knife stereotactic radiosurgery. Main Outcome Measures: Neuro-otological examinations including pure tone audiometry, auditory brain stem response, and caloric test. Results: Tumor growth occurred in 2 patients (4.3%). Seven (18%) of the 38 patients with preserved hearing of any extent became deaf within 1 year. In cases of gradual hearing loss, the average deterioration rate was approximately 8 dB per year. Abnormalities of auditory brain stem response preceded deafness in 2 patients. Caloric response, preserved before treatment in 13 patients, disappeared 4 to 13 months after treatment (median, 8 months) in 9 (69%) of them, whereas their hearing was preserved. Delayed facial palsy and persistent trigeminal neuropathy occurred in 10 (22%) and 7 (15%) of the 46 patients, respectively. Severe facial palsy tended to persist. Conclusions: The rates of neuro-otological complications of radiosurgery are almost comparable with those previously reported from other institutions. The deafness within 1 year after treatment might be attributed to a lesion in the cochlear nerve. Hearing loss did not parallel vestibular function loss. The persistent severe facial palsy contrasts with previously reported findings. Considering the serious facial nerve complications that occurred in some of our patients, further study to disclose the risk factors for neurological dysfunction would be needed for radiosurgery to become a true, safe alternative to microsurgery.Arch Otolaryngol Head Neck Surg. 1996;122:1229-1233 References 1. Leksell L. A note on the treatment of acoustic tumours . Acta Chir Scand . 1971; 137:763-765. 2. Wiegand DA, Fickel V. Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients . Laryngoscope . 1989;99:179-187.Crossref 3. Noren G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences . Neurosurgery . 1983;13:12-22.Crossref 4. Hirsch A, Noren G. Audiological findings after stereotactic radiosurgery in acoustic neurinomas . Acta Otolaryngol (Stockh) . 1988;106:244-251.Crossref 5. Noren G, Greitz D, Hirsch A, Lax I. Gamma knife radiosurgery in acoustic neurinoma . In: Steiner L, ed. Radiosurgery: Baseline and Trends . New York, NY: Raven Press; 1992:141-148. 6. Noren G, Greitz D, Hirsch A, Lax I. Gamma knife surgery in acoustic tumours . Acta Neurochir Suppl (Wien) . 1993;58:104-107. 7. Linskey ME, Lunsford LD, Flickinger JC. Radiosurgery for acoustic neurinomas: early experience . Neurosurgery . 1990;26:736-744.Crossref 8. Flickinger JC, Lunsford LD, Coffey RJ, et al. Radiosurgery of acoustic neurinomas . Cancer . 1991;67:345-353.Crossref 9. Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors . Neurosurg Clin North Am . 1992;3:191-205. 10. Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondziolka D. Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four-year results . Radiother Oncol . 1993;27:91-98.Crossref 11. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D. Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors . Arch Neurol . 1995;52:73-79.Crossref 12. Lunsford LD, Linskey ME. Stereotactic radiosurgery in the treatment of patients with acoustic tumors . Otolaryngol Clin North Am . 1992;25:471-491. 13. Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor stereotactic radiosurgery . Int J Radiat Oncol Biol Phys . 1993;25:227-233.Crossref 14. Sugasawa K, Mizuno M, Okuno T, Kitamura K, Kawamoto S, Sasaki T. Vestibular findings after stereotactic radiosurgery in acoustic neurinoma [in Japanese with English abstract] . Equilibrium Res (Japan) . 1994;53:276-281.Crossref 15. Sugasawa K, Ishii K, Takeuchi N, Kobayashi T, Mizuno M. Facial palsy after a stereotactic radiosurgery for acoustic neurinomas [in Japanese with English abstract] . Otolaryngol Head Neck Surg (Tokyo) . 1994;66:693-697. 16. House JW, Brackmann DE. Facial nerve grading system . Otolaryngol Head Neck Surg . 1985;93:146-147. 17. Schuknecht HF, Woellner RC. Hearing losses following partial section of the cochlear nerve . Laryngoscope . 1953;63:441-465. 18. Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery . Neurosurgery . 1995;36:215-229.Crossref 19. Brackmann DE, House JR, Hitselberger WE. Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas . Am J Otol . 1994; 15:614-619. 20. Niparko JK, Kileny PR, Kemink JL, Lee HM, Graham MD. Neurophysiologic intraoperative monitoring, II: facial nerve function . Am J Otol . 1989;10:55-61.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1996.01890230075014
Publisher site
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Abstract

Abstract Objective: To evaluate the neuro-otological complications in patients after radiosurgery for acoustic neurinomas. Design: Inception cohort, retrospective study. Setting: University hospital. Patients: A consecutive sample of 46 patients with acoustic neurinomas who underwent unilateral gamma knife radiosurgery at the University of Tokyo, Japan, between June 1990 and June 1994 were followed up by otolaryngologists for more than 3 months. Intervention: Gamma knife stereotactic radiosurgery. Main Outcome Measures: Neuro-otological examinations including pure tone audiometry, auditory brain stem response, and caloric test. Results: Tumor growth occurred in 2 patients (4.3%). Seven (18%) of the 38 patients with preserved hearing of any extent became deaf within 1 year. In cases of gradual hearing loss, the average deterioration rate was approximately 8 dB per year. Abnormalities of auditory brain stem response preceded deafness in 2 patients. Caloric response, preserved before treatment in 13 patients, disappeared 4 to 13 months after treatment (median, 8 months) in 9 (69%) of them, whereas their hearing was preserved. Delayed facial palsy and persistent trigeminal neuropathy occurred in 10 (22%) and 7 (15%) of the 46 patients, respectively. Severe facial palsy tended to persist. Conclusions: The rates of neuro-otological complications of radiosurgery are almost comparable with those previously reported from other institutions. The deafness within 1 year after treatment might be attributed to a lesion in the cochlear nerve. Hearing loss did not parallel vestibular function loss. The persistent severe facial palsy contrasts with previously reported findings. Considering the serious facial nerve complications that occurred in some of our patients, further study to disclose the risk factors for neurological dysfunction would be needed for radiosurgery to become a true, safe alternative to microsurgery.Arch Otolaryngol Head Neck Surg. 1996;122:1229-1233 References 1. Leksell L. A note on the treatment of acoustic tumours . Acta Chir Scand . 1971; 137:763-765. 2. Wiegand DA, Fickel V. Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients . Laryngoscope . 1989;99:179-187.Crossref 3. Noren G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences . Neurosurgery . 1983;13:12-22.Crossref 4. Hirsch A, Noren G. Audiological findings after stereotactic radiosurgery in acoustic neurinomas . Acta Otolaryngol (Stockh) . 1988;106:244-251.Crossref 5. Noren G, Greitz D, Hirsch A, Lax I. Gamma knife radiosurgery in acoustic neurinoma . In: Steiner L, ed. Radiosurgery: Baseline and Trends . New York, NY: Raven Press; 1992:141-148. 6. Noren G, Greitz D, Hirsch A, Lax I. Gamma knife surgery in acoustic tumours . Acta Neurochir Suppl (Wien) . 1993;58:104-107. 7. Linskey ME, Lunsford LD, Flickinger JC. Radiosurgery for acoustic neurinomas: early experience . Neurosurgery . 1990;26:736-744.Crossref 8. Flickinger JC, Lunsford LD, Coffey RJ, et al. Radiosurgery of acoustic neurinomas . Cancer . 1991;67:345-353.Crossref 9. Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors . Neurosurg Clin North Am . 1992;3:191-205. 10. Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondziolka D. Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four-year results . Radiother Oncol . 1993;27:91-98.Crossref 11. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D. Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors . Arch Neurol . 1995;52:73-79.Crossref 12. Lunsford LD, Linskey ME. Stereotactic radiosurgery in the treatment of patients with acoustic tumors . Otolaryngol Clin North Am . 1992;25:471-491. 13. Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor stereotactic radiosurgery . Int J Radiat Oncol Biol Phys . 1993;25:227-233.Crossref 14. Sugasawa K, Mizuno M, Okuno T, Kitamura K, Kawamoto S, Sasaki T. Vestibular findings after stereotactic radiosurgery in acoustic neurinoma [in Japanese with English abstract] . Equilibrium Res (Japan) . 1994;53:276-281.Crossref 15. Sugasawa K, Ishii K, Takeuchi N, Kobayashi T, Mizuno M. Facial palsy after a stereotactic radiosurgery for acoustic neurinomas [in Japanese with English abstract] . Otolaryngol Head Neck Surg (Tokyo) . 1994;66:693-697. 16. House JW, Brackmann DE. Facial nerve grading system . Otolaryngol Head Neck Surg . 1985;93:146-147. 17. Schuknecht HF, Woellner RC. Hearing losses following partial section of the cochlear nerve . Laryngoscope . 1953;63:441-465. 18. Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery . Neurosurgery . 1995;36:215-229.Crossref 19. Brackmann DE, House JR, Hitselberger WE. Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas . Am J Otol . 1994; 15:614-619. 20. Niparko JK, Kileny PR, Kemink JL, Lee HM, Graham MD. Neurophysiologic intraoperative monitoring, II: facial nerve function . Am J Otol . 1989;10:55-61.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Nov 1, 1996

References

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