{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:06:24Z","timestamp":1760148384716,"version":"3.43.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>It is uncertain which cochlear dose parameters significantly impact hearing after stereotactic radiosurgery (SRS) for sporadic vestibular schwannoma (VS). The objective of this study was to determine the impact of cochlear dose parameters on hearing outcomes for patients with serviceable hearing (SH).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a historical cohort study performed at a single tertiary center that included patients with sporadic VS and SH who underwent single-session Gamma Knife radiosurgery treatment from 2007 to 2022. Associations of cochlear dose parameters with time to non-SH and rates of change in pure-tone average (PTA) and word recognition score (WRS) following SRS were assessed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 205 patients with SH underwent SRS for a sporadic VS. At SRS, 54 (26%) tumors were confined to the internal auditory canal and 151 (74%) extended into the cerebellopontine angle. At 2, 5, and 10 years following SRS, 62%, 37%, and 15% of patients maintained SH, respectively. The median time to non-SH was 1.8 years. The median rates of change in PTA and WRS were 6.0 dB of hearing loss per year and \u22126.5% per year, respectively. In a multivariable analysis, each 1-Gy increase in minimum cochlear dose was significantly associated with time to non-SH (HR 1.5, 95% CI 1.2\u20131.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6\u20136.2), and rate of change in WRS percentage per year (PE \u22126.4, 95% CI \u221211.2 to \u22121.5). The associations of each 1-Gy increase in mean cochlear dose with hearing outcomes were only significant among patients with class B hearing (time to non-SH HR 1.3, 95% CI 1.1\u20131.6; rate of change in PTA PE 3.6, 95% CI 1.2\u20135.9; and rate of change in WRS PE \u22125.7, 95% CI \u22129.7 to \u22121.7).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The minimum cochlear dose impacts hearing outcomes after SRS for VS and should be considered in radiosurgical treatment planning. In this cohort, the mean cochlear dose was only associated with hearing outcomes in the subgroup of patients with class B hearing at SRS.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.7.jns24789","type":"journal-article","created":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T01:30:50Z","timestamp":1731720650000},"page":"1-8","source":"Crossref","is-referenced-by-count":1,"title":["Minimum cochlear dose impacts hearing after radiosurgery for sporadic vestibular schwannoma"],"prefix":"10.3171","author":[{"given":"Ramin A.","family":"Morshed","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl R.","family":"Khandalavala","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R.","family":"Dornhoffer","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric E.","family":"Babajanian","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghazal S.","family":"Daher","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Marinelli","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul D.","family":"Brown","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine M.","family":"Lohse","sequence":"additional","affiliation":[{"name":"Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Comprehensive Management of Vestibular Schwannoma","author":"Carlson ML","year":"2019","unstructured":"Carlson ML, Link MJ, Driscoll CLW. 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J Neurosurg. 2019;133(3):736\u2013741."},{"issue":"2","key":"b30","series-title":"Neurosurgery","first-page":"289","article-title":"Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing","volume":"64","author":"Tamura M","year":"2009","unstructured":"Tamura M, Carron R, Yomo S,  Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery. 2009;64(2):289\u2013296."},{"issue":"9","key":"b31","series-title":"Otol Neurotol","first-page":"1480","article-title":"Gamma Knife surgery of vestibular schwannomas: volumetric dosimetry correlations to hearing loss suggest stria vascularis devascularization as the mechanism of early hearing loss","volume":"31","author":"Wackym PA","year":"2010","unstructured":"Wackym PA, Runge-Samuelson CL, Nash JJ,  Gamma Knife surgery of vestibular schwannomas: volumetric dosimetry correlations to hearing loss suggest stria vascularis devascularization as the mechanism of early hearing loss. Otol Neurotol. 2010;31(9):1480\u20131487."},{"issue":"3-4","key":"b32","series-title":"World Neurosurg","first-page":"359","article-title":"Cochlea radiation dose correlates with hearing loss after stereotactic radiosurgery of vestibular schwannoma","volume":"80","author":"Hayden Gephart MG","year":"2013","unstructured":"Hayden Gephart MG, Hansasuta A, Balise RR,  Cochlea radiation dose correlates with hearing loss after stereotactic radiosurgery of vestibular schwannoma. World Neurosurg. 2013;80(3-4):359\u2013363."},{"issue":"6","key":"b33","series-title":"Otol Neurotol","first-page":"604","article-title":"Hearing preservation in observed sporadic vestibular schwannoma: a systematic review","volume":"43","author":"Khandalavala KR","year":"2022","unstructured":"Khandalavala KR, Saba ES, Kocharyan A,  Hearing preservation in observed sporadic vestibular schwannoma: a systematic review. Otol Neurotol. 2022;43(6):604\u2013610."},{"issue":"5","key":"b34","series-title":"JAMA","first-page":"421","article-title":"Upfront radiosurgery vs a wait-and-scan approach for small- or medium-sized vestibular schwannoma: the V-REX randomized clinical trial","volume":"330","author":"Dhayalan D","year":"2023","unstructured":"Dhayalan D, Tveiten \u00d8V, Finnkirk M,  Upfront radiosurgery vs a wait-and-scan approach for small- or medium-sized vestibular schwannoma: the V-REX randomized clinical trial. JAMA. 2023;330(5):421\u2013431."},{"key":"b35","series-title":"Int J Radiat Oncol Biol Phys","article-title":"Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: the VISAS Study","author":"Bin-Alamer O","unstructured":"Bin-Alamer O, Abou-Al-Shaar H, Peker S,  Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: the VISAS Study. Int J Radiat Oncol Biol Phys. Published online April 7, 2024. doi:10.1016\/j.ijrobp.2024.04.004"},{"issue":"4","key":"b36","series-title":"Neurosurgery","first-page":"641","article-title":"Matched comparison of hearing outcomes in patients with vestibular schwannoma treated with stereotactic radiosurgery or observation","volume":"91","author":"Schnurman Z","year":"2022","unstructured":"Schnurman Z, Gurewitz J, Smouha E,  Matched comparison of hearing outcomes in patients with vestibular schwannoma treated with stereotactic radiosurgery or observation. 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