Yonsei Med J.  2014 Jan;55(1):19-24. 10.3349/ymj.2014.55.1.19.

Change in Tinnitus after Treatment of Vestibular Schwannoma: Microsurgery vs. Gamma Knife Radiosurgery

• Park SH
• Oh HS
• Jeon JH
• Lee YJ
• Moon IS
• Lee WS

• KMID: 1779881
• DOI: http://doi.org/10.3349/ymj.2014.55.1.19

Abstract

PURPOSE
Tinnitus is a very common symptom of vestibular schwannoma, present in 45 to 80% of patients. We evaluated changes in tinnitus after translabyrinthine microsurgery (TLM) or gamma knife radiosurgery (GKS).
MATERIALS AND METHODS
Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance Hospital from 2009-2012, 46 patients with pre- or postoperative tinnitus who agreed to participate were enrolled. Pure tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS) scores for loudness, awareness, and annoyance were measured before and after treatment. Changes of THI and VAS were analysed and compared according to treatment modality, tumour volume, and preoperative residual hearing.
RESULTS
In the TLM group (n=27), vestibulocochlear nerves were definitely cut. There was a higher rate of tinnitus improvement in TLM group (52%) than GKS group (16%, p=0.016). The GKS group had a significantly higher rate of tinnitus worsening (74%) than TLM group (11%, p<0.001). Mean scores of THI and VAS scores significantly decreased in the TLM group in contrast to significant increases in the GKS group. Tumor volume and preoperative hearing did not affect the changes in THI or VAS.
CONCLUSION
GKS can save vestibulocochlear nerve continuity but may damage the cochlea, cochlear nerve and can cause worsening tinnitus. In cases where hearing preservation is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can sometimes relieve or prevent tinnitus.

Keyword

Vestibular schwannoma; tinnitus; microsurgery; gamma knife radiosurgery; cochlear nerve

MeSH Terms

Adult
Female
Humans
Male
Middle Aged
Neuroma, Acoustic/*surgery
Radiosurgery/*methods
Tinnitus/*surgery
Treatment Outcome

Figure

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  Fig. 1 Tumor volume was measured on magnetic resonance imaging using a three-dimensional reconstruction program (Aquarius iNtuition, TeraRecon). Serial images of axial (A), coronal (B) and sagittal (C) cuts of gadolinium-enhanced temporal MRI were input into the program; (D) the tumor was reconstructed three-dimensionally, and the tumor volume was automatically calculated.

• 

  Fig. 2 Proportion of patients with change in tinnitus. The TLM group (A) had a much higher rate of tinnitus improvement compared to the GKS (B) group (p=0.016), which showed a significantly higher rate of tinnitus aggravation (p<0.001). THI, tinnitus handicap inventory; TLM, translabyrinthine microsurgery; GKS, gamma knife radiosurgery.

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  Fig. 3 Mean scores of tinnitus handicap inventory (THI) (A) and visual analogue scale (VAS) (B) in the TLM group. THI (*p=0.006) and VAS in loudness (*p=0.014), awareness (p=0.006), and annoyance (*p=0.006) were decreased significantly. TLM, translabyrinthine microsurgery.

• 

  Fig. 4 Mean scores of THI (A) and VAS (B) in the GKS group. THI (*p<0.001) and VAS in loudness (*p=0.050) and annoyance (*p=0.034) were increased significantly. THI, tinnitus handicap inventory; VAS, visual analogue scale; GKS, gamma knife radiosurgery.

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