Hearing Rehabilitation with Cochlear Implants after CyberKnife Radiosurgery of Vestibular Schwannoma: A Report Based on Four Clinical Cases

Severe sensorineural hearing loss can be a symptom of the benign tumor vestibular
schwannoma (VS). The treatment of VS with non-invasive stereotactic radiosurgery (SRS) offers a
high local tumor control rate and an innovative possibility of sequential hearing rehabilitation with
cochlear implantation. This study evaluated the feasibility, complications, and auditory outcomes
of such a therapeutic approach. Three males and one female (mean age 65.3 9.4 years) scheduled
for cochlear implantation and diagnosed with sporadic VS classified as T1 or T2 (according to
Samii) were enrolled in this study. All patients had progressive hearing loss qualifying them for
cochlear implantation. First, the tumor was treated using CyberKnife SRS. Next, sequential auditory
rehabilitation with a cochlear implant (CI) was performed. Clinical outcomes and surgical feasibility
were analyzed, and audiological results were evaluated using pure tone audiometry and speech
recognition tests. All patients exhibited open-set speech understanding. The mean word recognition
score (at 65 dB SPL, Freiburg Monosyllabic Test, FMT) improved after cochlear implantation in all four
patients from 5.0 10% (with hearing aid) preoperatively to 60.0 22.7% six months postoperatively.
Our results suggest that in patients with profound hearing loss caused by sporadic vestibular
schwannoma, the tumor removal with SRS followed by cochlear implantation is an effective method
of auditory rehabilitation.