Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up

Lefranc, Michel; Róz, Leila Maria Da; Balossier, Anne; Thomassin, J.-M.; Roche, Pierre; Régis, Jean

doi:10.1016/j.wneu.2018.03.175

Cited by 35 publications

(31 citation statements)

References 36 publications

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“…Patients with large VSs are usually not considered for upfront SRS, because of the need for surgical decompression in clinically symptomatic patients and the risk of further clinical deterioration during transient tumor expansion after SRS [70,113]. Nevertheless, a few authors have assessed the feasibility and safety of primary SRS in asymptomatic large VS, reporting long-term tumor control up to 94% with good functional outcome and low complication rates [67,94]. Lefranc et al [94] reported the results of a large case series of a subgroup of 86 asymptomatic or minimally symptomatic patients with large VSs (defined as Koos Grade IV) treated by GKRS as first-line treatment.…”

Section: Radiosurgery and Radiation Therapymentioning

confidence: 99%

“…Nevertheless, a few authors have assessed the feasibility and safety of primary SRS in asymptomatic large VS, reporting long-term tumor control up to 94% with good functional outcome and low complication rates [67,94]. Lefranc et al [94] reported the results of a large case series of a subgroup of 86 asymptomatic or minimally symptomatic patients with large VSs (defined as Koos Grade IV) treated by GKRS as first-line treatment. After a mean follow-up of 6.2 years, tumor control with no clinical deterioration was achieved in 90.7% and no brainstem or cranial nerve toxicity was observed.…”

Section: Radiosurgery and Radiation Therapymentioning

confidence: 99%

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Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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Background and objective The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. Material and methods A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. Results Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. Conclusion The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.

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Section: Radiosurgery and Radiation Therapymentioning

confidence: 99%

Section: Radiosurgery and Radiation Therapymentioning

confidence: 99%

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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“…Seven out of 12 patients who had serviceable hearing before treatment kept their functional hearing. After GK, ventriculoperitoneal shunt was placed in two patients because of hydrocephalus and two patients experienced [112]. All patients underwent GK and the mean prescribed dose was 11 Gy.…”

Section: Primary Radiotherapy 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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“…15,37 It has also been evaluated in selected patients with larger tumors. 24 The goal of radiosurgery is long-term inactivation of tumor growth and preservation of cranial nerve function. Although facial nerve function is preserved in over 99% of patients, preservation of hearing is less successful.…”

Section: Vestibular Schwannomasmentioning

confidence: 99%

Current and novel practice of stereotactic radiosurgery

Kondziolka¹

2019

Journal of Neurosurgery

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Stereotactic radiosurgery emerged as a neurosurgical discipline in order to utilize energy for the manipulation of brain or nerve tissue, with the goal of minimal access and safe and effective care of a spectrum of neurosurgical disorders. Perhaps no other branch of neurosurgery has been so disruptive across the entire discipline of brain tumor care, treatment of vascular disorders, and management of functional problems. Radiosurgery is mainstream, supported by thousands of peer-reviewed outcomes reports. This article reviews current practice with a focus on challenges, emerging trends, and areas of investigation.

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Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up

Cited by 35 publications

References 36 publications

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

Current and novel practice of stereotactic radiosurgery

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