Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Huang, Marshall J.; Kano, Hideyuki; Mousavi, Seyed H.; Niranjan, Ajay; Monaco, Edward A.; Arai, Yoshinori; Flíckinger, John C.; Lunsford, L. Dade

doi:10.3171/2016.5.jns1645

Cited by 55 publications

(18 citation statements)

References 28 publications

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“…Thus, for large or giant acoustic neuromas with significant brainstem compression or hydrocephalus, the following combined approach should be considered: initial microsurgical brainstem decompression with functional and anatomical preservation of the neural structures, followed by radiosurgery for residual tumor. 18,22…”

Section: Evolution Of Radiosurgical Treatment Planning and Postradiosmentioning

confidence: 99%

Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

Frischer¹,

Gruber²,

Schöffmann³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma. METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up. RESULTS Four hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up. CONCLUSIONS In small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.

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Section: Evolution Of Radiosurgical Treatment Planning and Postradiosmentioning

confidence: 99%

Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

Frischer¹,

Gruber²,

Schöffmann³

et al. 2019

Journal of Neurosurgery

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“…Subtotal resection followed by observation or SRS, particularly for large VS, can achieve long term tumor control with improved CN preservation 6–7,32 . In general, small to medium VS <3 cm are managed differently than large VS, as surgery is often favored over SRS for large VS.…”

Section: Surgical Management Of Vsmentioning

confidence: 99%

The Management and Imaging of Vestibular Schwannomas

Lin¹,

Crane

2017

AJNR Am J Neuroradiol

112

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Vestibular schwannomas are the most common cerebellopontine angle tumor. Over the past century, the management goals of vestibular schwannomas have shifted from total resection to functional preservation. Current treatment options include surgical resection, stereotactic radiosurgery and observation. Imaging has become a crucial part of the initial screening, evaluation and follow up assessment of vestibular schwannomas. Recognizing and understanding the management objectives, various treatment modalities, expected post-treatment findings and complications allows the radiologists to play an essential role in a multidisciplinary team by providing key findings that are relevant to the treatment planning and outcome assessment. The authors provide a comprehensive discussion of the surgical management, role of radiation therapy and observation, imaging differential, and pre- and post-treatment imaging findings of vestibular schwannomas.

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“…That finding was consistent with our present findings with revision surgery; we found no recurrences after a mean follow-up of 41.5 months. In comparison, Huang et al recently reported a 94% tumor control rate with SRS for rVS after a median clinical follow-up of 74 months (47).…”

Section: Oncological Resultsmentioning

confidence: 93%

Surgery After Surgery for Vestibular Schwannoma: A Case Series

et al. 2020

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ObjectiveWe retrospectively evaluated the oncological and functional effectiveness of revision surgery for recurrent or remnant vestibular schwannoma (rVS).MethodsWe included 29 consecutive patients with unilateral hearing loss (16 women; mean age: 42.2 years) that underwent surgery for rVS. Previous surgeries included gross total resections (GTRs, n=11) or subtotal resections (n=18); mean times to recurrence were 9.45 and 4.15 years, respectively. House–Brackmann (HB) grading of facial nerve (FN) weakness (grades II-IV) indicated that 22 (75.9%) patients had deep, long-lasting FN paresis (HB grades: IV-VI). The mean recurrent tumor size was 23.3 mm (range: 6 to 51). Seven patients had neurofibromatosis type 2.ResultsAll patients received revision GTRs. Fourteen small- to medium-sized tumors located at the bottom of the internal acoustic canal required the translabyrinthine approach (TLA); 12 large and small tumors, predominantly in the cerebellopontine angle, required the retrosigmoid approach (RSA); and 2 required both TLA and RSA. One tumor that progressed to the petrous apex required the middle fossa approach. Fifteen patients underwent facial neurorrhaphy. Of these, 11 received hemihypoglossal–facial neurorrhaphies (HHFNs); nine with simultaneous revision surgery. In follow-up, 10 patients (34.48%) experienced persistent deep FN paresis (HB grades IV-VI). After HHFN, all patients improved from HB grade VI to III (n=10) or IV (n=1). No tumors recurred during follow-up (mean, 3.46 years).ConclusionsAggressive microsurgical rVS treatment combined with FN reconstruction provided durable oncological and neurological effects. Surgery was a reasonable alternative to radiosurgery, particularly in facial neurorrhaphy, where it provided a one-step treatment.

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Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Cited by 55 publications

References 28 publications

Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

The Management and Imaging of Vestibular Schwannomas

Surgery After Surgery for Vestibular Schwannoma: A Case Series

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