吳健豪 鄭博文 楊怡和* 亞東醫院 耳鼻喉科 台大醫院 耳鼻喉部* Sudden sensorineural hearing loss after cyberknife radiosurgery 電腦刀治療後的突發性聽損 吳健豪 鄭博文 楊怡和* 亞東醫院 耳鼻喉科 台大醫院 耳鼻喉部*

Treatment modalities Microsurgical resection Radiosurgical treatment Vestibular schwannoma Microsurgical resection Radiosurgical treatment Observation policy

Prevalence of VS (2005-2016,n=104) SSHL (8.6%) operation observation

Patients Group A (n=6) Group B (n=64) Group C (n=10) No treatment Sex: M / F = 3 / 7 Age: 20 - 72 (53) Y R / L= 3 / 7 Size: 0.64 ± 0.15 cm R/S With SHL Sex: M / F = 4 / 2 Age: 32 - 69 (51) Y R / L= 3 / 3 Size: 1.43 ± 0.51 cm R/S Without SHL Sex: M / F = 23 / 41 Age: 27 - 82 (54) Y R / L= 31 / 33 Size: 1.74 ± 0.92 cm p>0.05, btw’ Groups A and B

Clinical manifestation (n=6) 100 I: 21% (%) 33 17 17 Tinnitus Fullness Vertigo Headache

Clinical information 25 (m) 6 Interval after RS 3 17 (Gy) Dosage

Types of audiogram (n=6) 4 2 2 2 AAO (1995) A B C

Treatment Plasma expander (hydroxyethyl starch) 3.5L within 4 days. Antioxidants (N-acetylcysteine) 600 mg bid for 3 months.

M51, 12Gy, <1m interval

F69, 18Gy, 4m interval

Hearing outcome Hearing Level (dB) Frequency ( kHz ) -10 10 20 30 40 10 20 30 40 50 60 70 80 90 100 110 : improved : unchanged 17% 83% 0.5 1.0 2.0 3.0 Frequency ( kHz )

Vestibular test battery (pre-R/S) : normal : abnormal 83% 83% SVN cVEMP IVN 100%

Tumor size Group A Group B Group C 4 *: p>.05 a,b: p<0.001 (cm) 1.43 ± 0.51* 1.74 ± 0.92* 1.74 ± 0.92*, b 1.43 ± 0.51*, a 0.64 ± 0.15 a,b Group A Group B Group C

ROC curve analysis Cut off value of tumor size: 1.45 cm Sensitivity: 96% Specificity: 67% AUC: 0.773 p<.05

Conclusion Prevalence of SSHL in VS patients after radiosurgery: 8.6%. Radiosurgery is not a viable alternative to an observation protocol for VS patients with a tumor size <1.45 cm.

世界文化遺產: 長城 山海關