Stereotactic Radiosurgery in the Management of Vestibular Schwannoma and Glomus Jugulare

Jacob, Jeffrey T.; Pollock, Bruce E.; Carlson, Matthew L.; Driscoll, Colin L. W.; Link, Michael J.

doi:10.1016/j.otc.2015.02.010

Cited by 33 publications

(22 citation statements)

References 65 publications

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“…SRS is the most commonly used technique and converges multiple beams onto a delineated volume using cross-sectional imaging to minimize injury to adjacent tissues. Initial SRS dosage of 16–20 Gy marginal dose achieved a 98% tumor control rate but resulted in unacceptably high rates of early hearing loss (60%), and facial and trigeminal neuropathies (33%) 24,42–44 .…”

Section: Radiation Therapymentioning

confidence: 99%

“…Slightly lower doses of 12–13 Gy can be preferentially given to patients with serviceable hearing and slightly higher doses of 13–14 Gy to patients with poor hearing prognosis 44 .…”

Section: Radiation Therapymentioning

confidence: 99%

“…In one study, 5% of tumors enlarged following SRS but remained stable on subsequent imaging 72 . Most VS treated with SRS will subsequently decrease or remain stable in size, reflecting adequate tumor control 44 . Decreased enhancement centrally within the tumor is considered a positive response to therapy and is typically seen within 6 months following SRS 44 [Figure 9].…”

Section: Imagingmentioning

confidence: 99%

“…Most VS treated with SRS will subsequently decrease or remain stable in size, reflecting adequate tumor control 44 . Decreased enhancement centrally within the tumor is considered a positive response to therapy and is typically seen within 6 months following SRS 44 [Figure 9]. Radiation therapy may uncommonly induce cystic degeneration that may be secondary to microbleeding, increased vascular permeability or scarring of arachnoid adhesions 73 [Figure 9].…”

Section: Imagingmentioning

confidence: 99%

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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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Section: Radiation Therapymentioning

confidence: 99%

“…Slightly lower doses of 12–13 Gy can be preferentially given to patients with serviceable hearing and slightly higher doses of 13–14 Gy to patients with poor hearing prognosis 44 .…”

Section: Radiation Therapymentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

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The Management and Imaging of Vestibular Schwannomas

Lin¹,

Crane

2017

AJNR Am J Neuroradiol

112

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“…27–29 A review of patients treated with GKRS for vestibular schwannoma and GJT at the Mayo Clinic estimate the rate of preservation of serviceable hearing at 1 and 3 years respectively to be 80 and 55%. 30 Subjectively, 3 patients complained of worsening hearing after treatment while 1 patient reported improved hearing. Sensorineural hearing loss was the main component of hearing loss in our patients with 2 patients having a mixed hearing loss.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes for Single Modality Management of Glomus Jugulare Tumors With Stereotactic Radiosurgery

Dobberpuhl

Maxwell²,

Feddock³

et al. 2016

Otology &Amp; Neurotology

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Objectives The objectives were to evaluate the audiological outcomes, response of symptoms, and response of tumor volume in patients with glomus jugulare tumors treated solely with single fraction gamma knife radiosurgery. Study Design Single institution retrospective review. Setting Academic, tertiary referral center. Patients The diagnosis code for glomus jugulare was used to identify patients. Only those who underwent gamma knife radiosurgery were included. Those previously treated with any modality were excluded. A total of 12 patients were included for the tumor response and symptom response data and 7 of those were included in the audiometric analysis. Main Outcomes Measures Audiometric data at most recent follow up compared to presentation, subjective improvement in pulsatile tinnitus, and change in tumor volume at most recent follow up compared to pretreatment. Results The average time to most recent follow up was 27.6 months. There was no significant change in pure tone average or word recognition. Pulsatile tinnitus completely resolved or improved in 80% of patients. Cranial neuropathies were stable or improved. A single patient experienced facial nerve paresis 2 years after treatment, which resolved with steroid treatment. Tumor control was 100% and the average change in tumor volume was a decrease of 37%. Conclusion Single modality Gamma Knife radiosurgery treatment of glomus jugulare tumors appears to be safe. Treatment results in decreased tumor volume and improved pulsatile tinnitus in most patients. There was no significant progression of hearing loss after treatment. Lower cranial nerve function remains stable in all patients.

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