Dose Reduction Improves Hearing Preservation Rates after Intracanalicular Acoustic Tumor Radiosurgery

Dose Reduction Improves Hearing Preservation Rates after Intracanalicular Acoustic Tumor... AbstractOBJECTIVETo assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery.METHODSBetween August 1987 and December 1997, 29 patients with intracanalicular acoustic tumors underwent stereotactic radiosurgery at our center using the Leksell gamma knife (Elekta Instruments, Inc., Atlanta, GA). Fifteen assessable patients had serviceable preradiosurgery hearing (pure tone average, ≥50 dB; speech discrimination score, ≤50%). We retrospectively analyzed our hearing results and compared hearing preservation in patients who received a minimal tumor dose of 14 Gy or less versus those who received more than 14 Gy to the tumor margin.RESULTSNo perioperative patient morbidity or mortality was observed. Serviceable hearing was preserved in 11 (73%) of 15 assessable patients (actuarial rate, 65%). Long-term follow-up demonstrated serviceable hearing preservation in 10 (100%) of 10 patients who received marginal tumor doses of 14 Gy or less but in only one of five patients who received more than 14 Gy. Preradiosurgery Gardner-Robertson class was preserved in 49%, and testable hearing was present in 68% of patients who had any testable hearing at presentation. Five patients demonstrated improvement in hearing (three had serviceable and two had nonserviceable hearing before radiosurgery). No patient developed a facial or trigeminal neuropathy. Seven of 13 patients with preoperative tinnitus continued to experience tinnitus in follow-up. Episodic vertigo continued in 3 of the 11 patients who presented with vertigo.CONCLUSIONGamma knife radiosurgery (using conformal dose planning, small-beam geometry, and ≤14 Gy to the margin) prevents tumor growth and achieves excellent hearing preservation rates. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Dose Reduction Improves Hearing Preservation Rates after Intracanalicular Acoustic Tumor Radiosurgery

Dose Reduction Improves Hearing Preservation Rates after Intracanalicular Acoustic Tumor Radiosurgery

CLIN ICA L STUDIES Dose Reduction Improves Hearing Preservation Rates after Intracanalicular Acoustic Tumor Radiosurgery Ajay Niranjan, M.Ch., L. Dade Lunsford, M.D., john C. Flickinger, M.D., Ann Maitz, M.Sc., Douglas Kondziolka, M.D. D epartm ents o f N e u ro lo g ic a l Surgery (AN, LDL, JCF, A M , DK), Radiation O n c o lo g y (LDL, JCF, DK), and R adiology (LDL), U niversity o f Pittsburgh, and Center for Im a ge -G u ided N eurosurgery (AN, LDL, JCF, A M , DK), U niversity o f Pittsburgh M e d ic a l Center-Presbyterian, Pittsburgh, Pennsylvania OBJECTIVE: To assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery. METHODS: Between August 1987 and December 1997, 29 patients with intracanalicular acoustic tumors under­ went stereotactic radiosurgery at our center using the Leksell gamma knife (Elekta Instruments, Inc., Atlanta, G A ). Fifteen assessable patients had serviceable preradiosurgery hearing (pure tone average, ^ 5 0 dB; speech discrim ­ ination score, ^ 5 0 % ). W e retrospectively analyzed our hearing results and compared hearing preservation in patients who received a minimal tumor dose of 14 G y or less versus those who received more than 14 G y to the tumor margin. RESULTS: No perioperative patient morbidity or mortality was observed. Serviceable hearing was preserved in 11 (73%) of 15 assessable patients (actuarial rate, 6 5 % ). Long-term follow-up demonstrated serviceable hearing preservation in 10 (1 0 0 % ) of 10 patients who received marginal tumor doses of 14 G y or less but in only one of five patients who received more than 14 Gy. Preradiosurgery Gardner-Robertson class was preserved in 49 o, and testable hearing was present in 6 8 % of patients who had any testable hearing at presentation. Five patients demonstrated improvement in hearing (three had serviceable and two had nonserviceable hearing before radiosurgery). No patient...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199910000-00003
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVETo assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery.METHODSBetween August 1987 and December 1997, 29 patients with intracanalicular acoustic tumors underwent stereotactic radiosurgery at our center using the Leksell gamma knife (Elekta Instruments, Inc., Atlanta, GA). Fifteen assessable patients had serviceable preradiosurgery hearing (pure tone average, ≥50 dB; speech discrimination score, ≤50%). We retrospectively analyzed our hearing results and compared hearing preservation in patients who received a minimal tumor dose of 14 Gy or less versus those who received more than 14 Gy to the tumor margin.RESULTSNo perioperative patient morbidity or mortality was observed. Serviceable hearing was preserved in 11 (73%) of 15 assessable patients (actuarial rate, 65%). Long-term follow-up demonstrated serviceable hearing preservation in 10 (100%) of 10 patients who received marginal tumor doses of 14 Gy or less but in only one of five patients who received more than 14 Gy. Preradiosurgery Gardner-Robertson class was preserved in 49%, and testable hearing was present in 68% of patients who had any testable hearing at presentation. Five patients demonstrated improvement in hearing (three had serviceable and two had nonserviceable hearing before radiosurgery). No patient developed a facial or trigeminal neuropathy. Seven of 13 patients with preoperative tinnitus continued to experience tinnitus in follow-up. Episodic vertigo continued in 3 of the 11 patients who presented with vertigo.CONCLUSIONGamma knife radiosurgery (using conformal dose planning, small-beam geometry, and ≤14 Gy to the margin) prevents tumor growth and achieves excellent hearing preservation rates.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1999

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