Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

Radiosurgery has evolved into an effective alternative to microsurgical resection in the treatment of patients with vestibular schwannoma. We performed a systematic analysis of the literature in English on the radiosurgical treatment of vestibular schwannoma patients. A total of 254 published studies reported assessable and quantifiable outcome data of patients undergoing radiosurgery for vestibular schwannomas. American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B and Gardner-Robertson (GR) classification I or II were defined as having preserved hearing. A total of 5825 patients (74 articles) met our inclusion criteria. Practitioners who delivered an average dose of ⩽12.5 Gy as the marginal dose reported having a higher hearing preservation rate (⩽12.5 Gy = 59% vs. >12.5 Gy = 53%, p = 0.0285). Age of the patient was not a significant prognostic factor for hearing preservation rates (<65 years = 58% vs. >65 years = 62%; p = 0.4317). The average overall follow-up was 41.2 months. Our data suggest that an overall hearing preservation rate of about 57% can be expected after radiosurgical treatment, and patients treated with ⩽12.5 Gy were more likely to have preserved hearing.