Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non-vestibular schwannoma neoplasms of the lateral skull base: a cohort study
Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non-vestibular schwannoma neoplasms of the lateral skull base: a cohort study
复制标题
DOI：
10.3171/2019.4.jns19201
复制
发表时间：
2020-09-01
影响因子：
4.1
通讯作者：
Link, Michael J.
中科院分区：
文献类型：
--
作者：
Carlstrom, Lucas P.;Jacob, Jeffrey T.;Link, Michael J.
耳蜗辐射剂量被认为是影响前庭神经鞘瘤（VS）立体定向放射手术（SRS）后听力保护的关键因素。然而，耳蜗剂量对侧颅底非vs肿瘤（LSB）患者SRS后听力预后的预测价值尚不完整。作者调查了LSB非vs病变患者与vs患者在高剂量SRS后的听力损失发生率。方法2007-2016年期间接受SRS治疗的LSB脑膜瘤或颈副神经节瘤患者和可使用的预处理听力患者，接受小剂量剂量bbb50 Gy，纳入回顾性队列研究。结果16例非VS患者和43例VS患者的对照组符合研究标准。美国耳鼻喉头颈外科学会定义为A/B级的可用听力在13名非VS VS 23名VS患者中维持（81% VS 56%, p = 0.07）。3例非vs患者的听力损失均发生在桥小脑角（CPA）脑膜瘤。保留听力的非vs患者的中位剂量为6.9 Gy（范围5.7-19.2 Gy），而srs后听力损失患者的中位剂量为7.4 Gy（范围5.4-7.6 Gy） （p = 0.53）。散发性VS患者接受的总中位起始点剂量为6.8 Gy（范围5.4-11.7 Gy）。结论：5 Gy的摩尔剂量阈值不能预测非VS肿瘤患者接受SRS的听力损失，提示VS得出的剂量学参数可能不适用于该人群。听力损失的差异率似乎因病理而异，副神经节瘤和岩斜脑膜瘤与CPA脑膜瘤相比，听力损失的风险降低，CPA脑膜瘤可能直接压迫耳蜗神经，类似于VS。
OBJECTIVE Radiation dose to the cochlea has been proposed as a key prognostic factor in hearing preservation following stereotactic radiosurgery (SRS) for vestibular schwannoma ( VS). However, understanding of the predictive value of cochlear dose on hearing outcomes following SRS for patients with non-VS tumors of the lateral skull base (LSB) is incomplete. The authors investigated rates of hearing loss following high-dose SRS in patients with LSB non-VS lesions compared with patients with VS.METHODS Patients with LSB meningioma or jugular paraganglioma and serviceable pretreatment hearing who underwent SRS treatment during 2007-2016 and received a modiolus dose > 5 Gy were included in a retrospective cohort study, along with a similarly identified control group of consecutive patients with sporadic VS.RESULTS Sixteen patients with non-VS tumors and a control group of 43 patients with VS met study criteria. Serviceable hearing, defined as American Academy of Otololaryngology-Head and Neck Surgery class A/B, was maintained in 13 non-VS versus 23 VS patients (81% vs 56%, p = 0.07). All 3 instances of hearing loss in non-VS patients were observed in cerebellopontine angle (CPA) meningiomas. Non-VS with preserved hearing had a median modiolus dose of 6.9 Gy (range 5.7-19.2 Gy), versus 7.4 Gy (range 5.4-7.6 Gy) in those patients with post-SRS hearing loss (p = 0.53). Sporadic VS patients received an overall median modiolus point-dose of 6.8 Gy (range 5.4-11.7 Gy).CONCLUSIONS The modiolus dose threshold of 5 Gy does not predict hearing loss in patients with non-VS tumors undergoing SRS, suggesting that dosimetric parameters derived from VS may not be applicable to this population. Differential rates of hearing loss appear to vary by pathology, with paragangliomas and petroclival meningiomas demonstrating decreased risk of hearing loss compared to CPA meningiomas that may directly compress the cochlear nerve similarly to VS.