Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis

Tosi, Umberto; Lavieri, Miguel E. Tusa; An, Anjile; Maayan, Omri; Guadix, Sergio W.; DeRosa, Antonio; Christos, Paul J.; Pannullo, Susan C.; Stieg, Philip E.; Brandmaier, Andrew; Knisely, Jonathan; Ramakrishna, Rohan

doi:10.1093/nop/npab011

Cited by 15 publications

(6 citation statements)

References 52 publications

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“…Previously published GKRS and SRT experiences have shown excellent tumor control rates (84-100%), exceptional facial nerve function preservation (100% in ve series), cochlear nerve preservation (33-100%), and low treatment failure rates (0-12%) [6]. A recent systematic review and meta-analysis of the outcomes of SRS for large VSs revealed that 89% of patients achieved clinical control and 92% achieved radiographic control, with a 7% salvage surgery rate [52]. Con rming these ndings, all patients retained serviceable hearing and no facial nerve dysfunction was identi ed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

et al. 2022

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Background: Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the e cacy and safety of upfront SRS for large cVSs.Methods: The authors reviewed the data of 54 patients who received upfront, single-session GKRS with a diagnosis of large cVS (>4 cm3). Patients with neuro bromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded.Results: Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were KOOS grade IV (66.7%), and the most prevalent cyst pattern was "mixed pattern of small and big cysts" (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1-147 months). At GKRS, the median cVS volume was 6.95 cm 3 (range, 4.1-22 cm 3 ). The median marginal dose was 12 Gy (range, 10-12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24-169 months) and 94.9 ± 45.41 months (range, 24-175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n=50), tumor volume remained stable in 5.6% of patients (n=3), and tumor growth occurred in 1.9 percent of patients (n=1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume signi cantly decreased to 2.35 cm3 (p<0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, "multiple small thick-walled cyst pattern" and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I-II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n=1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus.Conclusions: Contrary to what was believed, our ndings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs.

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Section: Discussionmentioning

confidence: 99%

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

et al. 2022

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“…Current strategies include observation with imaging, stereotactic radiosurgery (SRS), or microsurgical resection. While observation may be reserved for slow‐growing lesions, SRS could be offered to patients ineligible to undergo surgery, with moderate risks of radiation‐induced complications 3 . Microsurgical resection offers the possibility of gross total resection (GTR), 4 yet surgical access to the IAC and CPA requires invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

“…While observation may be reserved for slow-growing lesions, SRS could be offered to patients ineligible to undergo surgery, with moderate risks of radiation-induced complications. 3 Microsurgical resection offers the possibility of gross total resection (GTR), 4 yet surgical access to the IAC and CPA requires invasive procedures. The middle fossa route approaches the pathology superiorly, while the retrosigmoid and translabyrinthine routes approach the pathology posteriorly.…”

Section: Introductionmentioning

confidence: 99%

Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review

et al. 2023

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ObjectiveExclusive endoscopic (EETTA) and expanded (ExpTTA) transcanal transpromontorial approaches have shown promising results for treating internal auditory canal (IAC) lesions. We reviewed the literature to answer the question: “Do EETTA and ExpTTA achieve high rates of complete resection and low rates of complications in treating patients with IAC pathologies?”Data SourcesPubMed, EMBASE, Scopus, Web of Science, and Cochrane were searched.Review MethodsStudies reporting EETTA/ExpTTA for IAC pathologies were included. Indications and techniques were discussed and meta‐analyzed rates of outcomes and complications were obtained with random‐effect model meta‐analyses.ResultsWe included 16 studies comprising 173 patients, all with non‐serviceable hearing. Baseline FN function was mostly House‐Brackmann‐I (96.5%; 95% CI: 94.9–98.1%). Most lesions were vestibular/cochlear schwannomas (98.3%; 95% CI: 96.7–99.8%) of Koos‐I (45.9%; 95% CI: 41.3–50.3%) or II (47.1%; 95% CI: 43–51.1%). EETTA was performed in 101 patients (58.4%; 95% CI: 52.4–64.3%) and ExpTTA in 72 (41.6%; 95% CI: 35.6–47.6%), achieving gross‐total resection in all cases. Transient complications occurred in 30 patients (17.3%; 95% CI: 13.9–20.5%), with meta‐analyzed rates of 9% (95% CI: 4–15%), comprising FN palsy with spontaneous resolution (10.4%; 95% CI: 7.7–13.1%). Persistent complications occurred in 34 patients (19.6%; 95% CI: 17.1–22.2%), with meta‐analyzed rates of 12% (95% CI: 7–19%), comprising persistent FN palsy in 22 patients (12.7%; 95% CI: 10.2–15.2%). Mean follow‐up was 16 months (range, 1–69; 95% CI: 14.7–17.4). Post‐surgery FN function was stable in 131 patients (75.8%; 95% CI: 72.1–79.5%), worsened in 38 (21.9%; 95% CI: 18.8–25%), and improved in 4 (2.3%; 95% CI: 0.7–3.9%), with meta‐analyzed rates of improved/stable response of 84% (95% CI: 76–90%).ConclusionTranspromontorial approaches offer newer routes for IAC surgery, but their restricted indications and unfavorable FN outcomes currently limit their use. Laryngoscope, 2023

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“…[2][3][4] Data regarding single-treatment SRS for VS with radiographic brainstem compression are limited and restricted to patients treated with Gamma Knife (GK). 5 A deficit in the literature is evaluation of the safety of treating VS with radiographic brainstem compression with a single-treatment SRS delivered through linear accelerator (linac). The purpose of this report is to fill this void by reporting outcomes in an unselected series of patients treated with a standardized approach at our institution.…”

mentioning

confidence: 99%

“…Data regarding single-treatment SRS for VS with radiographic brainstem compression are limited and restricted to patients treated with Gamma Knife (GK) 5 . A deficit in the literature is evaluation of the safety of treating VS with radiographic brainstem compression with a single-treatment SRS delivered through linear accelerator (linac).…”

mentioning

confidence: 99%

Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

De Leo,

Shah,

et al. 2023

American Journal of Clinical Oncology

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Objective: The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS. Methods: We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity. Results: Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%. Conclusion: Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.

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Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis

Cited by 15 publications

References 52 publications

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review

Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

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