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Francesco Ottaviani, MD; Cesare Bartolomeo Neglia, MD; Laura Ventrella, MD; Enrico Giugni, MD; Enrico Motti, MD

Arch Otolaryngol Head Neck Surg. 2002;128:1308-1312.

Objective  To evaluate the neuro-otological effects of gamma knife radiosurgery in patients with acoustic neurinoma.

Design  Prospective study.

Setting  University hospital in Milan, Italy.

Patients  Thirty consecutive patients with acoustic neurinoma who underwent gamma knife radiosurgery.

Intervention  Gamma knife radiosurgery.

Main Outcome Measures  Results of neuro-otological tests, including pure-tone audiometry, auditory brainstem responses, and transient evoked otoacoustic emissions, during a 2-year follow-up.

Results  Three patients showed slight tumor growth, 1 complained of a transient facial disturbance, and 5 complained of mild trigeminal disturbances. Seven of the 26 patients with a measurable threshold before radiosurgery experienced a 2-year decrease of more than 20 dB in at least 1 hearing level, and 2 of these became deaf in the affected ear. The analysis of auditory brainstem responses showed no significant increase in mean wave V latency after radiosurgery, but intensity of transient evoked otoacoustic emissions worsened in 9 of the 12 patients who had them before treatment. A statistically significant correlation was found between the 2-year decrease in low-tone average, pure-tone average, and high-tone average hearing levels and the 2-year decrease in transient evoked oacoustic emissions (P<.001, P = .008, and P<.001, respectively), and between the 2-year decrease in high-tone average hearing and the maximal cochlear dose (P = .03).

Conclusions  Although most patients had only a slight fluctuation of their hearing threshold after gamma knife radiosurgery, several experienced a remarkable hearing worsening. Hearing impairment was found to be mainly due to cochlear irradiation and maximal cochlear dose, which was correlated to hearing loss.

From the Departments of Otolaryngology (Drs Ottaviani and Neglia) and Neurosurgery (Drs Ventrella, Giugni, and Motti), University of Milan, Milan, Italy.

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