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

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

Systematic Review Document

Methodology

Number of Source Documents
178
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014