Fundal fluid cap is associated with hearing preservation in the radiosurgical treatment of vestibular schwannoma

Dennis I. Bojrab, Christian G. Fritz, Kenny F. Lin, Christopher A. Schutt, Robert S. Hong, Seilesh C. Babu, Peter Y. Chen, Ann Maitz, Dennis I. Bojrab

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To evaluate the relationship between fundal fluid and hearing outcomes after treatment of vestibular schwannoma (VS) with Gamma Knife radiosurgery (GKRS). Study Design: Retrospective case series. Setting: Tertiary neurotology referral center. Patients: Patients treated with GKRS for vestibular schwannoma between March 2007 and March 2017 were considered for this study. Exclusion criteria included pretreatment puretone average (PTA) >90 dB, neurofibromatosis type II, history of previous surgical resection, and follow-up less than 1 year. Main Outcome Measure(s): Hearing function was assessed both by preservation of serviceable hearing and by preservation of baseline hearing (≤20 dB change in PTA) after GKRS. Hearing preservation comparisons were made between groups of patients with and without a fundal fluid cap. Results: Patients with a fundal cap had significantly higher rates of baseline hearing preservation (≤20 dB change in PTA) according to Kaplan-Meier survival analysis of all 106 patients ( p=0.006). By the 3rd year posttreatment, 70.9% of patients with a fundal cap had maintained a ≤20 dB change in PTA, while only 43.6% of patients without a fundal fluid cap achieved this outcome ( p=0.004). Conclusions: Fundal fluid present on pretreatment magnetic resonance imaging is predictive of improved baseline hearing preservation rates in patients undergoing GKRS for vestibular schwannoma when considering all patients with PTA ≤90 dB. Fundal fluid cap presence may serve as a favorable prognostic indicator to help set hearing expectations and guide patient selection efforts.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalOtology and Neurotology
Issue number1
StatePublished - Jan 2021


  • Fundal fluid
  • Gamma knife
  • Hearing preservation
  • Stereotactic radiosurgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology


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