Gamma Knife Radiosurgery for Vestibular Schwannomas

Fukuoka, Seiji; Takanashi, Masami; Hojyo, Atsufumi; Konishi, Masanori; Tanaka, Chiharu; Nakamura, Hirohiko

doi:10.1159/000163382

Cited by 60 publications

(34 citation statements)

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“…5,13,19,23 However, 97% of our patients did not require microsurgery, which is well within the range of the 95%-99% rates observed in other studies. 3,13,15,19 The CN complication and hearing preservation rates we observed here do not appear to be different from those reported in previous studies.…”

Section: Discussionsupporting

confidence: 88%

“…3,13,15,19 The CN complication and hearing preservation rates we observed here do not appear to be different from those reported in previous studies. 3,5,7,13 In the following, we will discuss several possible explanations for these findings.…”

Section: Discussionmentioning

confidence: 96%

“…After applying our exclusion criteria, 8 articles remained in our literature-based analysis. 1,3,5,7,13,15,19,23 The tumor control and complication rates in these published cohorts are summarized in Table 4.…”

Section: Literature Searchmentioning

confidence: 99%

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Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

Klijn

Verheul

Beute

et al. 2016

JNS

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OBJECT The authors of this study sought to assess tumor control and complication rates in a large cohort of patients who underwent Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) and to identify predictors of tumor control. METHODS The records of 420 patients treated with GKRS for VS with a median marginal dose of 11 Gy were retrospectively analyzed. Patients with neurofibromatosis Type 2 or who had undergone treatment for VS previously were excluded. The authors assessed tumor control and complication rates with chart review and used the Cox proportional hazards model to identify predictors of tumor control. Preservation of serviceable hearing, defined as Gardner-Robertson Class I–II, was evaluated in a subgroup of 71 patients with serviceable hearing at baseline and with available follow-up audiograms. RESULTS The median VS tumor volume was 1.4 cm3, and the median length of follow-up was 5.1 years. Actuarial 5-and 10-year tumor control rates were 91.3% and 84.8%, respectively. Only tumor volume was a statistically significant predictor of tumor control rate. The tumor control rate decreased from 94.1% for tumors smaller than 0.5 cm3 to 80.7% for tumors larger than 6 cm3. Thirteen patients (3.1%) had new or increased permanent trigeminal nerve neuropathy, 4 (1.0%) had new or increased permanent facial weakness, and 5 (1.2%) exhibited new or increased hydrocephalus requiring a shunting procedure. Actuarial 3-year and 5-year hearing preservation rates were 65% and 42%, respectively. CONCLUSIONS The 5-year actuarial tumor control rate of 91.3% in this cohort of patients with VS compared slightly unfavorably with the rates reported in other large studies, but the complication and hearing preservation rates in this study were similar to those reported previously. Various factors may contribute to the observed differences in reported outcomes. These factors include variations in treatment indication and in the definition of treatment failure, as well as a lack of standardization of terminology and of evaluation of complications. Last, differences in dosimetric variables may also be an explanatory factor.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

Klijn

Verheul

Beute

et al. 2016

JNS

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“…In more recent series with at least 3 years of follow-up, hearing preservation has been reported at 32%-71% when a < 13-Gy marginal dose is delivered. 5,7,11,14,19,31 Facial nerve preservation ranged from 73% to 100% in these patients.…”

Section: Durability Of Hearing Preservationmentioning

confidence: 90%

Durability of hearing preservation after microsurgical treatment of vestibular schwannoma using the middle cranial fossa approach

Wang

Chinn

Than³

et al. 2013

JNS

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V estibular schwannomas are relatively rare, accounting for approximately 8% of all intracranial tumors. 50 They arise from the vestibular portions of the eighth cranial nerve, which runs in conjunction with the seventh cranial nerve through the CPA into the IAC, where the Obersteiner-Redlich transition zone occurs. 21 Approximately 5% of cases are associated with neurofibromatosis Type 2. 51 The most common presentation is progressive unilateral hearing loss. In a natural history study by Stangerup et al., 48 growth after diagnosis of intracanalicular VS was observed in 64% of cases in the 1st year, in an additional 23% by the 2nd year, and in 5% more by the 3rd year.The widespread use of MRI has resulted in earlier diagnosis of VS, such that patients with very small lesions and excellent residual hearing in the involved ear often present for treatment consideration. Hearing preservation is a reasonable primary goal of management in such cases. Object. The middle cranial fossa (MCF) approach is a microsurgical technique described as a primary option in the treatment of small, intracanalicular schwannomas involving the eighth cranial nerve. Excellent rates of complete tumor resection, hearing preservation, preservation of facial nerve function, and low complication rates have been reproduced using this technique. However, the durability of hearing preservation attained using the various treatment options has not been adequately assessed. The purpose of this study was to evaluate the durability of long-term hearing preservation in patients with vestibular schwannoma (VS) treated via the MCF approach. The authors hypothesize that hearing preservation in these patients will prove to be durable years after treatment in a high percentage of cases.Methods. Retrospective medical chart review was performed in 103 consecutive patients undergoing resection of VS via a modified MCF approach between 1999 and 2008. Patients in whom surgical goals were gross-total resection and hearing preservation were included. Preoperative and postoperative hearing assessment was performed using standard audiometric testing, and classified according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines as a primary outcome measure. Outcomes and neurological complications initially, and at 1, 3, and 5 years following operation were analyzed.Results. Initial hearing preservation rates were in keeping with the best previously published results. At initial postoperative audiometric follow-up, of the patients presenting with Class A hearing, 67% remained Class A, 17% were Class B, 1% were Class C, and 15% were Class D. Of patients presenting with Class B hearing, 24% were Class A, 53% remained Class B, 6% were Class C, and 18% were Class D. Of patients presenting with Class C hearing, 100% remained Class C.To assess the durability of hearing preservation in our patients, the authors evaluated hearing function at regular intervals after the initial postoperative audiometric follow-up. Audiometric data were available ...

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“…Numerous reports (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) of the long-term outcomes after SRS using marginal tumor doses of 12-13 Gy ( Fig. 1), with excellent progression-free survival (range, 92-100%), have been published (Table 3).…”

Section: Single-session Srsmentioning

confidence: 99%