Babajanian, Eric E.

AbstractObjectiveTo examine associations with changes in quality‐of‐life (QOL) outcomes following treatment of vestibular schwannoma (VS) using stereotactic radiosurgery (SRS).Study DesignProspective longitudinal study.SettingTertiary academic center.MethodsPatients who were treated for sporadic VS using SRS from 2015 to 2022 were included. QOL outcomes were measured using the disease‐specific Penn Acoustic Neuroma QOL (PANQOL) scale.ResultsSeventy‐nine patients with pre‐SRS and at least one post‐SRS PANQOL assessments were available for analysis. The mean change in total PANQOL scores was −2 (SD 13) on a 100‐point scale. The mean duration between assessments was 4.6 years (SD 2.0). Age at SRS, sex, and SRS treatment doses were not significantly associated with changes in total PANQOL scores. Total PANQOL scores improved a mean of 4 points for patients with tumors confined to the internal auditory canal but declined a mean of 5 points for patients with tumors extending into the cerebellopontine angle (P = .01); however, these changes did not exceed the minimum clinically significant threshold of 11 points. The correlation coefficient between treated tumor volume at SRS and change in total PANQOL scores was −0.30 (P = .007). Changes in PANQOL total (P = .5) and hearing domain (P = .3) scores for patients who maintained serviceable hearing or progressed to nonserviceable hearing did not significantly differ.ConclusionTumor extent and treated volume at SRS had a statistically significant but likely not clinically important impact on total PANQOL scores. Progression to nonserviceable hearing did not have a significant impact on PANQOL total or hearing domain scores.

OBJECTIVE 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). METHODS 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. RESULTS 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 −6.5% 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 1.2–1.9), rate of change in PTA decibel hearing loss per year (parameter estimate [PE] 3.4, 95% CI 0.6–6.2), and rate of change in WRS percentage per year (PE −6.4, 95% CI −11.2 to −1.5). 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 1.1–1.6; rate of change in PTA PE 3.6, 95% CI 1.2–5.9; and rate of change in WRS PE −5.7, 95% CI −9.7 to −1.7). CONCLUSIONS 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.

AbstractObjectiveStereotactic radiosurgery (SRS) is increasingly used for small‐to‐medium‐sized sporadic vestibular schwannoma (VS) and is associated with good tumor control and low‐risk of adverse radiation‐associated events. The exact mechanism of VS tumor control is unknown but may relate to microvascular hyalinization and resultant tumoral ischemia. This study examined associations of microvascular risk factors with outcomes following SRS.DesignHistorical cohort of patients who underwent SRS for sporadic VS from 2000 to 2022.SettingTertiary academic center.MethodsAssociations of microvascular risk factors with tumor control and complications were evaluated using Cox proportional hazards regression.ResultsIn total 749 patients were studied, 31% with a history of smoking, 38% obesity, 19% hypertension, 8% diabetes, 3% peripheral vascular disease, and 2% history of coronary bypass. Regarding tumor control, no factor was associated with salvage treatment following SRS (n = 42). Hypertension (hazard ratio [HR] 2.81; P = .02) and coronary bypass (HR 6.91; P = .002) were significantly associated with developing facial nerve paresis (n = 22). No significant associations with new facial spasms (n = 53) were identified. Lastly, 191 of 294 patients with serviceable hearing at SRS progressed to nonserviceable hearing at a median 2.0 years (interquartile range: 1.0‐5.0). After multivariable adjustment for age and ipsilateral hearing status, the HR for the association of smoking history with time to nonserviceable hearing was 1.46 (95% confidence interval 1.04‐2.04; P = .03).ConclusionWe demonstrate that hypertension and history of coronary bypass may be associated with development of facial nerve weakness, while smoking may be associated with accelerated hearing loss in patients undergoing SRS for sporadic VS. These data may help guide patient counseling and inform decision‐making regarding treatment.

Objectives: During cochlear implant (CI) electrode placement, single low-frequency (e.g., 500 Hz) cochlear microphonics (CM) measurements are used to monitor hair-cell function and provide feedback to avert insertion trauma. However, it can be difficult to differentiate between trauma and the electrode’s progression through the cochlea when monitored with a single frequency. Multi-frequency CM measurements, while more complex to analyze, can provide more accurate feedback by measuring CM from various locations along the basilar membrane. Methods: A new algorithm was developed to analyze multi-frequency CM tracings by comparing amplitude and phase changes across different test frequencies. The new algorithm was evaluated as to its ability to identify drop-alarm instances with the multi-frequency approach, as compared to single-frequency 500 Hz tracings. Results: The algorithm presented in this manuscript uses the relationship between CM amplitude and phase changes across frequencies to provide real-time feedback during CI electrode placement. The results show that multi-frequency CM tracings raised an alarm only 0.5 times, as compared to 2.8 instances of alarm raised for the single-frequency 500 Hz CM measurements. Conclusions: Multi-frequency CM tracings can help reduce the number of alarms which may be false positives prompting unnecessary electrode manipulations, thereby minimizing the risk of insertion trauma.

Objective To evaluate the long-term changes in sporadic vestibular schwannoma (VS) disease-specific quality-of-life (QOL) outcomes. Study Design Prospective longitudinal study using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale. Setting National survey. Patients Patients with sporadic VS who completed a baseline survey before treatment and at least one follow-up survey recruited through the authors’ center and through the Acoustic Neuroma Association. Interventions Observation, microsurgery, radiosurgery. Main Outcome Measures Changes in PANQOL scores from baseline to most recent survey. Results Among 445 eligible patients the mean duration of follow-up was 4.4 (SD, 2.3) years, including 122, 218, and 105 in the observation, microsurgery, and radiosurgery groups, respectively. Patients managed with observation (p = 0.03) or microsurgery (p < 0.001) demonstrated improvement in anxiety scores. Changes in facial function scores differed significantly by management group (p = 0.01), with patients undergoing microsurgery demonstrating a mean decline of 10 points in facial function scores compared with mean declines of 3 for those managed with observation or radiosurgery. Hearing loss scores decreased similarly over time for all three groups (p = 0.3). There were minimal changes in total PANQOL scores over time across all management groups (p = 0.5). Conclusions Long-term changes in total QOL among VS management groups are not significantly different. Microsurgery may continue to confer an advantage regarding improvement in anxiety postoperatively, but with a greater decline in facial function when compared to observation or radiosurgery. Long-term declines in hearing loss scores were not statistically significantly different among groups.

ObjectiveTo evaluate patients who become symptomatic from superior semicircular canal dehiscence (SSCD) following head trauma.Study DesignCase series assessing patients presenting with SSCD after a trauma.MethodsA case series was completed assessing patients presenting with SSCD after trauma. Data from three academic medical centers were evaluated, including the following: imaging, videonystagmography (VNG)/vestibular evoked myogenic potential (VEMP) testing, audiometric assessment, and surgical repair. Outcome measures included the following: 1) Description of audio‐vestibular symptoms, 2) mean pre‐ and post‐operative pure tone average (PTA), word recognition score (WRS), and air bone gap (ABG).ResultsA total of 14 patients were included; 86% were male. Approximately 43% were found to have bilateral SSCD on imaging, with 57% of patients pursuing surgical management. The most common presenting symptoms included pulsatile tinnitus (93%), autophony (79%), and hearing loss (64%). Approximately 36% of patients underwent VNG/VEMP testing, with 83.3% of those demonstrating abnormal results. The mean audiometric findings on the symptomatic side included an air‐conduction PTA of 38.0 dB, bone‐conduction PTA of 24.3 dB, WRS of 81%, and ABG of 17.9 dB. Among patients who underwent surgery (57%), there was no significant change in the air‐conduction PTA, bone‐conduction PTA, or WRS (P > .05). However, there was an improvement in the ABG (preoperative = 22.8 dB versus postoperative = 9.7 dB; P = .005).ConclusionHead trauma may be a potentiating event for SSCD syndrome. This study advances the hypothesis that these patients likely have underlying radiographic SSCD prior to their trauma, and a traumatic event increases in intra‐vestibular or intracranial pressures, unmasking SSCD syndrome.Level of Evidence4 Laryngoscope, 131:E2810–E2818, 2021