Gamma Knife radiosurgery following subtotal resection of vestibular schwannoma

Brokinkel, Benjamin; Sauerland, Cristina; Holling, Markus; Ewelt, Christian; Horstmann, Gerhard A.; Eck, Albertus T C J van; Stummer, Walter

doi:10.1016/j.jocn.2014.03.037

Cited by 54 publications

(21 citation statements)

References 31 publications

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“…In the present study, we achieved a 100% tumor control rate, with 87% of our patients showing excellent facial nerve function in the follow-up. These rates are higher than those usually reported following MS, which range from 31.4 to 92.8% in recent studies [18,19], specifically in the subgroup of patients with large tumors.…”

Section: Discussioncontrasting

confidence: 65%

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

Radwan

Eisenberg²,

Knisely³

et al. 2016

Stereotact Funct Neurosurg

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Background: The debate continues with a limited number of publications describing outcomes in patients with vestibular schwannoma (VS) treated with planned subtotal resection (STR) plus stereotactic radiosurgery (SRS). Here we present our experience. Methods: This is a retrospective review of 22 patients with VS Koos grade III and IV who were treated with STR followed by SRS. Tumor volumes, facial nerve function, hearing preservation, and the presence of trigeminal neuropathy were noted. Spearman's rank test was used to correlate facial nerve grade with postoperative tumor residual tumor volume. Results: Tumor control was achieved in all patients with a mean follow-up of 28 months. No patient required other treatment beyond the original surgery and adjuvant SRS during this period. After a mean postoperative period of 28 months, 19/22 patients had excellent (House-Brackmann I or II) facial nerve function grading. Improved facial nerve function was positively correlated with larger residual tumor volume (r_s = 0.63). Kaplan-Meier curve showed around 80% probability for regaining facial nerve function after initial deterioration. Four patients reported postoperative facial numbness at the side of surgery, with 3 cases showing improvement within a month. Temporary postoperative caudal cranial nerve dysfunction was observed in 2 patients. Conclusion: Hybrid strategy of STR and adjuvant SRS provides patients with large VS excellent tumor control and a good clinical outcome.

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Section: Discussioncontrasting

confidence: 65%

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

Radwan

Eisenberg²,

Knisely³

et al. 2016

Stereotact Funct Neurosurg

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“…In Van de Langenberg’s series of 50 patients with the same surgical strategy [69], an excellent facial nerve outcome (H–B I or II) was achieved in 94% and hearing was preserved in 1 out of 4 patients. A recent systematic review by Brokinkel et al [4] analyzed 6 studies of GKRS following subtotal resection. There were 159 patients with a tumor diameter more than 2 cm.…”

Section: Discussionmentioning

confidence: 99%

Preserving normal facial nerve function and improving hearing outcome in large vestibular schwannomas with a combined approach: planned subtotal resection followed by gamma knife radiosurgery

et al. 2017

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ObjectiveTo perform planned subtotal resection followed by gamma knife surgery (GKRS) in a series of patients with large vestibular schwannoma (VS), aiming at an optimal functional outcome for facial and cochlear nerves.MethodsPatient characteristics, surgical and dosimetric features, and outcome were collected prospectively at the time of treatment and during the follow-up.ResultsA consecutive series of 32 patients was treated between July 2010 and June 2016. Mean follow-up after surgery was 29 months (median 24, range 4–78). Mean presurgical tumor volume was 12.5 cm3 (range 1.47–34.9). Postoperative status showed normal facial nerve function (House–Brackmann I) in all patients. In a subgroup of 17 patients with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 16 (94.1%) retained serviceable hearing. Among them, 13 had normal hearing (Gardner–Robertson class 1) before surgery, and 10 (76.9%) retained normal hearing after surgery. Mean duration between surgery and GKRS was 6.3 months (range 3.8–13.9). Mean tumor volume at GKRS was 3.5 cm3 (range 0.5–12.8), corresponding to mean residual volume of 29.4% (range 6–46.7) of the preoperative volume. Mean marginal dose was 12 Gy (range 11–12). Mean follow-up after GKRS was 24 months (range 3–60). Following GKRS, there were no new neurological deficits, with facial and hearing functions remaining identical to those after surgery in all patients. Three patients presented with continuous growth after GKRS, were considered failures, and benefited from the same combined approach a second time.ConclusionOur data suggest that large VS management, with planned subtotal resection followed by GKRS, might yield an excellent clinical outcome, allowing the normal facial nerve and a high level of cochlear nerve functions to be retained. Our functional results with this approach in large VS are comparable with those obtained with GKRS alone in small- and medium-sized VS. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.

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“…In this study, the numbers of 24 patients harbored a cystic VS and 26 a solid VS Analysis showed that cystic VSs required less time to shrink than solid VS, with mean half reduction times equal to 2.58 and 14.34 years, respectively. The theory behind planned combined therapy is a safe resection minimizing the risk of FN injury and better control of the residual tumor by applying a dose of radiation [115][116][117]. Data related to the radiation type, dose delivered, recurrence, radiation-induced side effects and functional outcomes are summarized in Table 2.…”

Section: Planned Radiotherapy After Subtotal Resection In Large Vsmentioning

confidence: 99%

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

Yao

Alahmari

Temel

et al. 2020

Cancers

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Vestibular schwannoma (VS) is a benign primary brain tumor that occurs sporadic or as part of a genetic syndrome. The most common cause is the mutation of the NF2 tumor suppressor gene that is involved in the production of the protein merlin. Merlin plays a role in cell growth and cell adhesion. In patients with NF2, the VSs arise bilaterally and coincide with other brain tumors. In sporadic VS, the tumor is typically unilateral and does not coincide in combination with other tumors. MRI is the standard imaging technique and can be used to assess the size and aspect of the tumor as well as the progression of disease. The preferred management of large VS in both VS types is surgery with or without adjuvant radiation. The management for the medium- or small-sized VS includes wait and scan, radiotherapy and/or surgery. This choice depends on the preference of the patient and institutional protocols. The outcomes of surgical and radiotherapy treatments are improving due to progress in surgical equipment/approaches, advances in radiation delivery techniques and dose optimizations protocols. The main purpose of the management of VS is preserving function as long as possible in combination with tumor control.

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Gamma Knife radiosurgery following subtotal resection of vestibular schwannoma

Cited by 54 publications

References 31 publications

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

Preserving normal facial nerve function and improving hearing outcome in large vestibular schwannomas with a combined approach: planned subtotal resection followed by gamma knife radiosurgery

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

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