Cochlear Implantation within One Month of Stereotactic Radiosurgery for Vestibular Schwannomas: A Retrospective Review

Background: The long-term hearing preservation rate after stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) is ~25% and is worse if the patient has impaired hearing prior to treatment. Therefore, hearing rehabilitation should be considered in these patients. Recent evidence suggests that patients undergoing cochlear implantation (CI) after SRS for vestibular schwannomas are associated with favorable audiometric outcomes. Both procedures are typically performed at a tertiary referral center, which provide care for patients from a large geographic region. It can be difficult for many patients to coordinate multiple trips to a large referral center when they live in a geographically remote area. In this series, we present our experience with CI performed within a month of SRS treatment for VS.

Methods: The authors conducted a retrospective chart review of adult patients with VS who underwent SRS followed by CI within 1 month at a single tertiary care referral center between 2015 and 2022. Patient demographics, tumor pathology, treatment parameters, and pre- and post-implantation audiometric and clinical outcomes are presented.

Results: Ten patients underwent SRS followed by CI within one month during the study period. Four (40%) patients had neurofibromatosis type 2 (NF2). The median age at treatment was 65.5 years (range: 36–84 years) and 8 patients were male (80%). The median marginal dose was 13 Gy with a median treatment volume of 1,100 mm³. The median time from SRS to CI was 1.0 days (range: 0–31 days). The mean pre-implantation AzBio sentence score was 8.9% (range: 0–36%). Overall, 8 patients (80%) demonstrated open-set speech understanding. Sentence testing was performed at a median of 12 months (range: 6–24 months). The mean post-implantation AzBio sentence score was 68.4% (range: 44–94%). One patient had environmental sound awareness and one patient did not use the implant due to pain.

Conclusion: CI after SRS for VS provides excellent audiometric outcomes. Placement of the CI in the immediate post-treatment period after SRS is convenient for the patient and does not demonstrate a decrement in the clinical outcomes. When feasible, we would recommend placement of a CI immediately after SRS in select patients who would benefit from the implant to expedite their hearing rehabilitation.

Publication History

Article published online:
01 February 2023