Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients

Tonn, Joerg‐Christian; Schlake, Hans-Peter; Goldbrunner, Roland; Milewski, Ch.; Helms, J.; Roosen, K.

doi:10.1136/jnnp.69.2.161

Cited by 119 publications

(57 citation statements)

References 22 publications

(20 reference statements)

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“…In two other large series, Sindou et al [6] and Knosp et al [7] reported a trigeminal and visual cranial nerve deficit incidence of between 14 and 58%. Similarly, even with microsurgical resection with intra-operative monitoring, facial nerve dysfunction occurs in up to 7% of patients [26][27][28][29] and hearing loss is universally observed in most acoustic neuromas exceeding 2-3 cm in diameter [30][31][32]. Hence, radiation therapy has been a preferred choice for such tumors with preserved neurological function.…”

Section: Hypofractionatedmentioning

confidence: 99%

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Mahadevan¹,

Floyd²,

Wong

et al. 2011

Computer Aided Surgery

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Section: Hypofractionatedmentioning

confidence: 99%

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Mahadevan¹,

Floyd²,

Wong

et al. 2011

Computer Aided Surgery

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“…It remains challenging to perform a direct comparison of facial nerve preservation rates even among larger surgical series, as this is dependent on variables including tumor size, location, and surgical expertise. 3,25,26,36 FSRT for AN utilizing a dose schedule of 50 Gy over 5 weeks was well tolerated, with minimal associated acute toxicity. We did report, however, 1 case (1.6% incidence) of a significant late toxicity, a radiation-induced glioblastoma.…”

Section: Discussionmentioning

confidence: 99%

“…4,23,24 The ability to achieve complete resection and maintain neurologic function is dependent on tumor size, location, and the surgical approach used. 3,[25][26][27] Stereotactic radiosurgery (SRS), utilizing either a linac or GK-based system approach, is a noninvasive alternative to surgery, with comparable local control rates demonstrated. 9,[28][29][30][31] Due to the close proximity of most tumors to the brainstem, the risks of cranial nerve dysfunction secondary to marginal doses have resulted in initially higher complication rates with SRS, 29,30 although these have now decreased over recent years concomitant with reduction in the total dose prescribed, improved expertise, and better patient selection.…”

Section: Discussionmentioning

confidence: 99%

“…Microsurgery has been the traditional treatment, representing a safe and effective treatment with resultant excellent local control rates ranging from 94% to 99%. 3,4 Other treatment options for AN include fractionated stereotactic radiotherapy (FSRT) 1,5,6 and stereotactic radiosurgery-using both linear accelerator (linac) 7 and gamma knife (GK)-based approaches. 8,9 Alternatively, in selected cases a conservative management approach may be a desirable alternative.…”

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confidence: 99%

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Fractionated stereotactic radiotherapy for acoustic neuroma

Koh

Millar

Ménard

et al. 2007

Cancer

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BACKGROUND.The clinical outcome and toxicity of fractionated stereotactic radiotherapy (FSRT) was assessed for acoustic neuroma in 60 patients treated in a single institution.METHODS.Between October 1996 and February 2005, 60 patients received FSRT for acoustic neuroma (AN). The mean total dose applied was 50 Gy in single daily 2‐Gy fractions over 5 weeks. The median irradiated tumor volume was 4.9 cm3 (range, 0.3–49.0 cm3). The median follow‐up period was 31.9 months.RESULTS.FSRT was well tolerated in all patients. The 5‐year actuarial local control rate was 96.2% (95% CI: 91.1%–100.0%). Five‐year actuarial progression‐free survival was 92.8% (95% CI: 84.8%–100.0%). The overall hearing preservation rate was 77.3%. Five of 6 patients with initial cranial nerve V (CNV) numbness remained stable post‐FSRT. Two of 3 patients with baseline trigeminal neuralgia improved with the remaining patient stable. All 3 patients with nonsurgically related facial nerve weakness either improved or achieved stability in function. There were no cases of new cranial nerve toxicity post‐FSRT.CONCLUSIONS.FSRT for the treatment of AN is safe, effective, and well tolerated. FSRT should thus be considered as an effective alternative treatment modality when compared with microsurgical resection or single fraction stereotactic radiosurgery. Cancer 2007. © 2007 American Cancer Society.

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“…The incidence rate of VS has been increased because of detection the small and early stage VS by routine use of MRI in approach to hearing disturbance [15,[31][32][33][34][35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Mastronardi

Cacciotti

Roperto

et al. 2016

Caspian.J.Neurol.Sci

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Background: Vestibular Schwannoma (VS) is one of the skull base tumors originating from vestibular portion of eighth cranial nerve. Recently, 2 microThulium laser is used in the surgery of some intracranial tumors. Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laser fiber (Revolixjr ® ) in microsurgical removal of VS. Materials and Methods:This retrospective non-randomized study was carried out from July 2012 to November 2015. 39 patients with VS had been operated on with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiber hand-held flexible laser was used for tumor resection in 39 cases. Facial nerves function by House-Brackmann (HB) scale and hearing state were assessed preoperatively and 1 week and 6-month postoperatively. Results: Overall time of surgery changed only in proportion with the size of tumor (185-575 minutes) and was not affected by the use of laser. In 5out of 39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent) was observed. On considering 38 cases, at 6-month follow-up facial nerve preservation rate (HB1) was 92.1% (from May 2015 all patients had not postoperative facial palsy). Hearing preservation rate was possible in 12 out of 15 cases with previously acceptable preoperative hearing state (AAO-HNS A and B classes). The mean surgeon satisfaction rate of usefulness of this technic was 2.7 in a 0-3-scale Conclusions: A good functional outcome including facial nerve preservation and hearing preservation was obtained by micro-Thulium-fiber hand-held flexible laser microsurgery.

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Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients

Cited by 119 publications

References 22 publications

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Fractionated stereotactic radiotherapy for acoustic neuroma

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

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