1. 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*

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

3. Prevalence of VS ( ,n=104)
SSHL
(8.6%)
operation
observation

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

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

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

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

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

9. M51, 12Gy, <1m interval

10. F69, 18Gy, 4m interval

11. Hearing outcome Hearing Level (dB) Frequency ( kHz ) -10 10 20 30 4010 20 30 40 50 60 70 80 90
100
110
: improved
: unchanged
17%
83%
0.5
1.0
2.0
3.0
Frequency ( kHz )

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

13. 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

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

15. 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.

16. 世界文化遺產: 長城 山海關