• Methma Udawatta, Isabelle Kwan, Komal Preet, Thien Nguyen, Vera Ong, John P Sheppard, Courtney Duong, Prasanth Romiyo, Percy Lee, Stephen Tenn, Tania Kaprealian, Quinton Gopen, and Isaac Yang.
• Department of Neurosurgery, University of California, Los Angeles, California, USA; David Geffen School of Medicine, University of California, Los Angeles, California, USA.
• World Neurosurg. 2019 Sep 1; 129: e303-e310.

BackgroundVestibular schwannomas (VS) are benign intracranial neoplasms arising from the eighth cranial nerve for which targeted radiation therapy (RT) has proved increasingly successful. However, long-term hearing and related cranial nerve outcomes have been disputed for the 3 current RT modalities.ObjectiveTo determine differences in hearing preservation for patients treated with stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), or hypofractionated stereotactic radiotherapy (hypoFSRT) for VS.MethodsA retrospective electronic chart review was conducted for all patients with unilateral VS treated with primary RT at a single academic medical center between 2000 and 2017. The primary outcome measure was preservation of serviceable hearing status in the affected ear at last follow-up. Secondary outcomes included tinnitus, vertigo, and imbalance.ResultsA total of 33 FSRT cases, 21 SRS cases, and 6 hypoFSRT cases were identified. Postoperative deterioration in serviceable hearing and tinnitus showed significant differences across cohorts. The SRS cohort had a higher baseline incidence of nonserviceable hearing and disequilibrium compared with other cohorts before RT (P = 0.001 and 0.022, respectively); no differences in baseline morbidity were observed for vertigo and tinnitus. The 5-year tumor control rate was 95.2%, 93.9%, and 100% with SRS, FSRT, and hypoFSRT, respectively.ConclusionsOur series indicated an excellent tumor control rate in all the modalities. Our SRS cohort showed increased incidence and shorter time to hearing deterioration compared with the FSRT and hypoFSRT cohorts. The FSRT and hypoFSRT cohorts have shown comparable overall outcomes. Onset of post-RT tinnitus was observed only with FSRT.Copyright © 2019. Published by Elsevier Inc.

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