Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas скачать в хорошем качестве

Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,[email protected], https://plus.google.com/communities/1... ,https://plus.google.com/u/0/+Alexandr... ,   / @otolaryngologistorlent-med3259  ,    / @alexandrosg.sfakianakis4746  , https://twitter.com/g_orl?lang=el,   / alexandrossfakianakis  , Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas. Neurosurgery. 2017 Dec 20;: Authors: Carlson ML, Vivas EX, McCracken DJ, Sweeney AD, Neff BA, Shepard NT, Olson JJ Abstract Question 1: What is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is moderately high probability (50%-75%) of hearing preservation at 2 yr, moderately high probability (50%-75%) of hearing preservation at 5 yr, and moderately low probability (25%-50%) of hearing preservation at 10 yr. Question 2: Among patients with AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery hearing classification) class A or GR (Gardner-Robertson hearing classification) grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery, utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (75%-100%) of hearing preservation at 2 yr, moderately high probability (50%-75%) of hearing preservation at 5 yr, and moderately low probability (25%-50%) of hearing preservation at 10 yr. Question 3: What patient- and tumor-related factors influence progression to nonserviceable hearing following stereotactic radiosurgery using ≤13 Gy to the tumor margin? Recommendation: Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size, marginal tumor dose ≤12 Gy, and cochlear dose ≤4 Gy. Age and sex are not strong predictors of hearing preservation outcome. Question 4: What is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (25%-50%) of hearing preservation immediately following surgery, moderately low probability (25%-50%) of hearing preservation at 2 yr, moderately low probability (25%-50%) of hearing preservation at 5 yr, and moderately low probability (25%-50%) of hearing preservation at 10 yr. Question 5: Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (50%-75%) of hearing preservation immediately following surgery, moderately high probability (50%-75%) of hearing preservation at 2 yr, moderately high probability (50%-75%) of hearing preservation at 5 yr, and moderately low probability (25%-50%) of hearing preservation at 10 yr. Question 6: What patient- and tumor-related factors influence progression to nonserviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas? Recommendation: Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a dis