Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery

Karpinos, Marianna; Teh, Bin S.; Zeck, Otto; Carpenter, L. Steven; Phan, Chris; Yuan, Wei; Lu, Haiquan; Chiu, J. Kam; Butler, E. Brian; Gormley, William B.; Woo, Shiao Y.

doi:10.1016/s0360-3016(02)03651-9

Cited by 193 publications

(116 citation statements)

References 39 publications

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“…21,28,34,39,46,53 Surgery has been the only therapeutic option available for a long time, and the costs are high mortality and morbidity rates. In the past the preservation of hearing function was a difficult goal to achieve.…”

Section: Discussionmentioning

confidence: 99%

“…43,52 Several scientific studies have shown how radiosurgery is currently considered the best treatment for smallsized tumors. 9,14,21,22,26,41,44 According to the guidelines for the treatment of VSs approved by the International RadioSurgery Association 15 published in May 2006, patients with intracanalicular tumors in whom growth has been documented on imaging, patients with tumors of maximum diameter < 3 cm and no brainstem distortion, and patients with a postsurgical residual lesion, even if > 3 cm, are candidates for GKS.Indeed, recent studies have shown a tumor growth control rate of 93-100% after GKS. 4,[6][7][8][9][10][11][12][13][14]16,[22][23][24][25]30,32 Complications (deficit of CNs V and VII) are extremely rare.…”

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confidence: 99%

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Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Franzin¹,

Spatola²,

Serra³

et al. 2009

FOC

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Object Due to technological advances in neuroradiology in recent years, incidental diagnoses of vestibular schwannomas (VSs) have increased. The aim of this study was to evaluate the hearing function after treatment with Gamma Knife surgery (GKS) for VSs in patients adequately selected with “good” or “useful” hearing before treatment and to assess the possible predictive factors for hearing function preservation. Methods Of all patients treated in the authors' hospital between 2001 and 2007, they retrospectively studied 50 patients with a unilateral VS in whom there was serviceable hearing (Gardner-Robertson [GR] Class I or II). Additional inclusion criteria were: no Type 2 neurofibromatosis, no previous treatment, and at least 6 months' follow-up of neuroradiological and audiological data. The median patient age was 54 years (range 24–78 years). The median tumor volume was 0.73 ml (range 0.03–6.6 ml), and the median radiation dose to the tumor margin was 13 Gy (range 12–16 Gy) with an isodose of 50%. Results Patient age, tumor volume, and presenting symptoms were found to correlate with hearing function. At a median of 36 months after radiosurgery, tumor growth control was 96% and no patient required any other additional treatment. Serviceable hearing was preserved in 34 patients (68%): 21 (62%) with GR Class I hearing and 13 (38%) with GR Class II hearing. The remaining 16 patients had poor hearing function:15 with GR Class III and 1 with GR Class IV hearing function. In 19 (58%) of 33 patients with GR Class I function before GKS the same class was maintained posttreatment; 29 (88%) maintained functional hearing (GR Class I or II). In all patients with an intracanalicular lesion, functional hearing was maintained. Significant prognostic factors for maintaining serviceable hearing were GR Class I function before treatment, symptoms at presentation, patient age younger than 54 years, and Koos Stage T1 disease. Conclusions The results of the study show that the probability of preserving functional hearing in patients undergoing GKS treatment for unilateral VSs is very high. Patients with GR Class I, age younger than 54 years, with presenting symptoms other than hearing loss, and a Koos Stage T1 tumor have better prognosis. The prescribed dose of 13 Gy appears to represent an excellent compromise between controlling the disease and preserving auditory function.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Franzin¹,

Spatola²,

Serra³

et al. 2009

FOC

View full text Add to dashboard Cite

show abstract

“…9,15,16,21 Furthermore, Roos et al performed an analysis of 44 patients treated with primary SRS for small and medium VSs with a minimum of 10 years of follow-up and found a tumor control rate of 97.7% (1 patient required salvage resection), highlighting the durability of this treatment. 22 Among our patients with large VSs, the tumor control rate at 5 years is clearly lower (81.8%); however, our data are consistent with other recent reports of GKS for large VSs (82%-94% tumor control rate).…”

Section: Tumor Controlmentioning

confidence: 99%

Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size

Williams

Xu²,

Salvetti³

et al. 2013

JNS

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Object. Gamma Knife surgery (GKS) is a safe and effective treatment for patients with small to moderately sized vestibular schwannomas (VSs). Reports of stereotactic radiosurgery for large VSs have demonstrated worse tumor control and preservation of neurological function. The authors endeavored to assess the effect of size of VSs treated using GKS.Methods. This study was a retrospective comparison of 24 patients with large VSs (> 3 cm in maximum diameter) treated with GKS compared with 49 small VSs (≤ 3 cm) matched for age, sex, radiosurgical margin and maximal doses, length of follow-up, and indication.Results. Actuarial tumor progression-free survival (PFS) for the large VS cohort was 95.2% and 81.8% at 3 and 5 years, respectively, compared with 97% and 90% for small VSs (p = 0.009). Overall clinical outcome was better in small VSs compared with large VSs (p < 0.001). Patients with small VSs presenting with House-Brackmann Grade I (good facial function) had better neurological outcomes compared with patients with large VSs (p = 0.003). Treatment failure occurred in 6 patients with large VSs; 3 each were treated with resection or repeat GKS. Treatment failure did not occur in the small VS group. Two patients in the large VS group required ventriculoperitoneal shunt placement. Univariate analysis did not identify any predictors of treatment failure among the large VS cohort.Conclusions. Patients with large VSs treated using GKS had shorter PFS and worse clinical outcomes compared with age-, sex-, and indication-matched patients with small VSs. Nevertheless, GKS has efficacy for some patients with large VSs and represents a reasonable treatment option for selected patients.

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“…The traditional standard of care for the treatment of large AN has been microsurgical excision, which to date has proven to be the treatment modality with the most longterm eYcacy compared with SRS or observation alone [6,14,16]. However, with the recent advent of FSRT for small and medium-sized AN demonstrating low morbidity and excellent clinical eYcacy, it is possible that FSRT may represent an eVective noninvasive alternative to microsurgery in patients with large AN [7,10].…”

Section: Discussionmentioning

confidence: 99%

Treatment of a Large Acoustic Tumor with Fractionated Stereotactic Radiotherapy

McClelland¹,

Gerbi

Cho

et al. 2010

Radiosurgery

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The treatment of acoustic neuromas (AN) usually involves surgical excision or stereotactic radiosurgery. However, for large AN (mean diameter > 3 cm), stereotactic radiosurgery is rarely used, leaving patients with limited noninvasive treatment options. Recently, the use of fractionated stereotactic radiotherapy (FSRT) has been eVective in treating small to medium-sized AN. We present a patient with a large AN treated with FSRT. The patient was a 43-year-old man presenting with imbalance, tinnitus, vertigo, and right-sided hearing decline associated with vomiting and hydrocephalus. Magnetic resonance (MR) imaging revealed a large, 3.8-cm, right cerebellopontine-angle tumor compressing the fourth ventricle. Following right frontal ventriculoperitoneal shunt placement, the patient underwent FSRT for treatment of the tumor. Using the Radionics X-Knife 4.0 3D treatment planning system, a total of 54 Gy was delivered in 1.8-Gy daily fractions with the prescription isodose line of 90%. Treatments were delivered using a dedicated Varian 6/100 linear accelerator, and head immobilization was achieved with the Gill-Thomas-Cosman relocatable stereotactic frame. The patient was subsequently evaluated with serial contrast-enhanced MR imaging. Following FSRT, local control (deWned as the absence of tumor progression) was achieved, and treatment was well tolerated. There was no hearing-related, trigeminal, or facial-nerve morbidity following FSRT at 63-month follow-up. Treating a patient with a large AN with FSRT resulted in local tumor control, with no trigeminal nerve, facial nerve, or hearing-related morbidity. These results support FSRT as a potential noninvasive treatment modality for AN some would consider too large for single-fraction stereotactic radiosurgery (SRS).

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Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery

Cited by 193 publications

References 39 publications

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size

Treatment of a Large Acoustic Tumor with Fractionated Stereotactic Radiotherapy

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