Acoustic Neuroma Treated with Stereotactic Radiosurgery: Follow-up of 335 Patients

Rueß, Daniel; Pöhlmann, Lea; Hellerbach, Alexandra; Hamisch, Christina; Hoevels, Mauritius; Treuer, Harald; Grau, Stefan; Jabłońska, Karolina; Köcher, Martin; Ruge, Maximilian I.

doi:10.1016/j.wneu.2018.04.149

Cited by 31 publications

(35 citation statements)

References 24 publications

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“…The association of reduced local control with increased tumor volumes has been the subject of ongoing discussion [13]. Analyzing local control for tumors smaller and larger than the median volume (0.61 ccm) resulted in local control of 97.4%, 94.4%, and 94.4% at three, five and 10 years for the smaller and 95.7%, 90.3%, and 87.7% for the larger group, which corresponds to a recent study by Ruess et al where, for a group of 335 patients with a median tumor volume of 1.1 ccm, local control was 89% and 87% at five and 10 years, respectively [14]. These differences, especially in long-term control, should be considered when deciding to place smaller tumors under surveillance.…”

Section: Local Tumor Controlsupporting

confidence: 86%

Clinical Results After Single-fraction Radiosurgery for 1,002 Vestibular Schwannomas

Windisch¹,

Tonn²,

Fürweger³

et al. 2019

Cureus

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Background Herein, we report clinical results for patients treated with stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) over a period of 10 years. Methods Clinical data and imaging follow-up were stored in a database of 1,378 patients, with 1,384 VS treated consecutively between 2005 and 2018 and analyzed retrospectively. A total of 996 patients with 1,002 tumors with at least one year of follow-up were included for analysis. Results Median follow-up was 3•6 years (1-12•5 years). The three, five, and 10-year Kaplan-Meier estimated local tumor control was 96•6%, 92•3%, and 90•8%, respectively. The median hearing loss of the affected ear as compared to its healthy counterpart was 17 dB at treatment start and increased to 23 and 29 dB at one and five years. Six patients (0•6%) developed symptomatic hydrocephalus and underwent the placement of a ventriculoperitoneal shunt. In 30 patients (3•0%), trigeminal sensory dysfunction developed, five patients (0•5%) had a mild transient weakness, and nine patients (0•9%) had a permanent facial weakness (House-Brackmann Grade > II) after SRS. Conclusion Single fraction SRS proves to be highly effective and shows low treatment-related toxicity for VS. SRS should be considered a primary treatment option for small and middle-sized VS.

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Section: Local Tumor Controlsupporting

confidence: 86%

Clinical Results After Single-fraction Radiosurgery for 1,002 Vestibular Schwannomas

Windisch¹,

Tonn²,

Fürweger³

et al. 2019

Cureus

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“…Comparing GKS to other forms of stereotactic radiosurgery and fractionated radiotherapy, there is some controversy in the literature. Rueß et al analyzed a group of 335 patients with VS treated with Cyberknife or LINAC, where forty‐eight patients (44.9%) lost functional hearing during the follow‐up period of 13 and 30 months, respectively, but the probability of hearing preservation amounted to 89%, 80%, and 57% after 1, 2, and 5 years …”

Section: Discussionmentioning

confidence: 99%

“…23 In our study, we would like to emphasize the role of active dose reduction to the cochlea by means of dose optimizing (reduction to 11.5Gy in some selected cases) as well as the application of all the planning strategies available in Gamma Plan respectively, but the probability of hearing preservation amounted to 89%, 80%, and 57% after 1, 2, and 5 years. 26 The presented deterioration of hearing with time may be due to a lack of dosimeter optimization of the cochlear dose (even monitoring), which seems of paramount importance, as well as the frameless approach that may play role in the microanatomical environment of the internal auditory canal. Vestibular dysfunction, which has been reported to be more common among small and medium vestibular schwannomas is important predictors of reduced quality of life.…”

Section: Class Descriptionmentioning

confidence: 99%

“…In the majority of reports, radiological tumor progression signals the need for irradiation. Previous smaller studies demonstrated that GKS is a promising method for IVS management, providing excellent tumor growth control rates (91%‐100%) and good hearing preservation rates (41%‐76%) . In this paper, we present the outcomes of GKS in the largest group of patients with IVS studied to date, putting particular emphasis on the mid‐to‐long‐term outcomes of the treatment.…”

Section: Introductionmentioning

confidence: 98%

“…Previous smaller studies demonstrated that GKS is a promising method for IVS management, providing excellent tumor growth control rates (91%-100%) and good hearing preservation rates (41%-76%). 7,11,[20][21][22][23][24][25][26] In this paper, we present the outcomes of GKS in the largest group of patients with IVS studied to date, putting particular emphasis on the mid-to-long-term outcomes of the treatment. Patients with incomplete surgical excision of VS (with the intracanalicular part left intact) and those diagnosed with neurofibromatosis were not included in the analysis.…”

Section: Introductionmentioning

confidence: 99%

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Gamma knife surgery in the treatment of intracanalicular vestibular schwannomas

Dzierzęcki

Czapski²,

Dyttus-Cebulok

et al. 2020

Acta Neurol Scand

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Objective According to the literature, gamma knife surgery (GKS) is a promising method for intracanalicular vestibular schwannoma (IVS) management, providing excellent tumor growth control rates (91%‐100%) and good hearing preservation rates (41%‐76%), but this evidence originates primarily from a small series of patients. The aim of this study was to present the outcomes of GKS in the largest group of patients with IVS studied to date, with particular emphasis on the long‐term outcomes of treatment. Methods The study included 136 consecutive patients with unilateral IVS, who underwent GKS in 2011‐2015. Mean age of the patients was 54 ± 12.6 years. All patients were operated on with a 192‐source cobalt‐60 gamma knife unit. All patients had complete follow‐up documentation and the mean duration of the follow‐up was 52 ± 13.8 months (6‐83 months). Neurological status (facial and trigeminal nerve), hearing and instability/dizziness presence were determined prior to GKS, immediately after the procedure, and during the follow‐up visits. Results Tumor growth control was obtained in 124/136 (~91.2%) patients. Hearing improvement was observed in 32/136 (23.5%) patients, and there was a distinct cluster of 9 patients (6.6%) regaining serviceable hearing after GKS, whereas in 36 patients (26.5%) was stable. Four patients developed facial nerve dysfunction, including 3 periodic hemifacial spasm and 1 partial paresis, which resolved spontaneously within 12 months of GKS. None of the operated patients showed new, debilitating neurological deficits, including trigeminal sensory disturbances or hydrocephalus. Conclusions GKS is a highly effective treatment for IVS, associated with low morbidity and good tumor growth control.

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