Hearing Preservation Outcomes In Patients With Sporadic Vestibular Schwannomas
Publication Date: February 1, 2018
Last Updated: March 14, 2022
Recommendations
STEREOTACTIC RADIOSURGERY
Individualswho meet these criteria and are considering stereotactic radiosurgery should be counseled that there is moderately high probability (>50%- 75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. (Level III)
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Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. (Level III)
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Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size, marginal tumor dose ≤12 Gy, and cochlear dose ≤4 Gy. Age and sex are not strong predictors of hearing preservation outcome. (Level III)
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MICROSURGERY
Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (>25%- 50%) of hearing preservation immediately following surgery, moderately low probability (>25%-50%) of hearing preservation at 2 yr, moderately low probability (>25%-50%) of hearing preservation at 5 yr, and moderately lowprobability (>25%-50%) of hearing preservation at 10 yr. (Level III)
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Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (>50%- 75%) of hearing preservation immediately following surgery, moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately lowprobability (>25%-50%) of hearing preservation at 10 yr. (Level III)
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Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a distal internal auditory canal cerebrospinal fluid fundal cap. Age and sex are not strong predictors of hearing preservation outcome. (Level III)
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CONSERVATIVE OBSERVATION
Individuals who meet these criteria and are considering observation should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. (Level III)
318512
Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, and moderately high probability (>50%-75%) of hearing preservation at 5 yr. Insufficient datawere available to determine the probability of hearing preservation at 10 yr for this population subset. (Level III)
318512
Individuals who meet these criteria and are considering observation should be counseled regarding probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, as well as nongrowth of the tumor. Tumor size at the time of diagnosis, age, and sex do not predict future development of nonserviceable hearing during observation. (Level III)
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Recommendation Grading
Overview
Title
Hearing Preservation Outcomes In Patients With Sporadic Vestibular Schwannomas
Authoring Organization
Congress of Neurological Surgeons
Publication Month/Year
February 1, 2018
Last Updated Month/Year
August 7, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
It provides general consensus regarding long-term preservation of useful hearing
Target Patient Population
Patients With Sporadic Vestibular Schwannomas
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Management
Diseases/Conditions (MeSH)
D015837 - Vestibular Diseases, D011300 - Preoperative Care, D009464 - Neuroma, Acoustic, D009442 - Neurilemmoma, D016634 - Radiosurgery
Keywords
hearing loss, acoustic neuroma, neurilemmoma, radiosurgery
Source Citation
Neurosurgery, Volume 82, Issue 2, February 2018, Pages E35–E39, https://doi.org/10.1093/neuros/nyx511
Supplemental Methodology Resources
Methodology
Number of Source Documents
178
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014