Introduction: Vestibular schwannomas are increasingly diagnosed in patients with normal hearing because of advances in magnetic resonance imaging. We sought to evaluate whether stereotactic radiosurgery (SRS) performed earlier after diagnosis improved long-term hearing preservation in this population.

Methods: We queried our prospectively gathered quality assessment registry and found the records of 1,134 acoustic neuroma patients who underwent SRS during a 15-year period (1997-2011). We identified 88 patients who had vestibular schwannomas, but normal hearing with no subjective hearing loss at the time of diagnosis. All patients were Gardner-Robertson class I at the time of SRS. Fifty-seven patients underwent early (<2 years from diagnosis) SRS and 31 patients underwent late (>2 years after diagnosis) SRS. At a median follow-up time of 75 months, we evaluated patient outcomes.

Results: Tumor control rates were defined as tumors that were decreased or stable in size. Control rates were similar in the early (95%) and late (90%) treatment groups (P=0.73). Patients in the early treatment group retained serviceable (Gardner-Robertson class I/II) hearing and normal (Gardner-Robertson class I) hearing longer than did patients in the late treatment group (serviceable hearing, P=0.006; normal hearing, P<0.0001, respectively). At 5 years after SRS, an estimated 88% of the early treatment group retained serviceable hearing and 77% retained normal hearing, compared with 55% with serviceable hearing and 33% with normal hearing in the late treatment group.

Conclusions: SRS within 2 years after initial diagnosis of a vestibular schwannoma in normal hearing patients was associated with improved retention of all hearing measures compared with later SRS treatments in a similar patient cohort.

Patient Care: Earlier treatment of vestibular schwannomas may result in improved hearing preservation versus treatment once clinically-relevant hearing deficits manifest.

Learning Objectives: Treating vestibular schwannomas earlier with SRS may result in higher rates of hearing preservation versus late treatment

References: Akpinar B, Mousavi SH, McDowell MM, Niranjan A, Faraji AH, Flickinger JC, Lunsford LD. Int J Radiat Oncol Biol Phys. 2016 Jun 1;95(2):729-34.