RSS-Feed abonnieren
DOI: 10.1055/s-0041-1729977
Gamma Knife Radiosurgery for Large Vestibular Schwannoma More Than 10 cm3: A Single-Center Indian Study
![](https://www.thieme-connect.de/media/jnlsb/2022S02/lookinside/thumbnails/10-1055-s-0041-1729977_200335-1.jpg)
Abstract
Introduction Gamma Knife radiosurgery (GKRS) is an effective treatment for benign vestibular schwannomas (VSs). The established cutoffs have recently been challenged, as recent literature expanded the horizon of GKRS to larger tumors. Even though microsurgery remains the primary option for large VS, GKRS can provide reasonable tumor control and is more likely to avoid cranial neuropathies associated with open surgery.
Methods We analyzed patients with VS with volume exceeding 10 cm3 who underwent GKRS at our center from January 2006 to December 2016. Clinicoradiological and radiosurgical data were collected from medical records for statistical analysis. Follow-up was performed every 6 months with a clinical assessment along with magnetic resonance imaging (MRI) of the brain and audiometric evaluation in patients with serviceable hearing.
Results The study included 34 patients (18 males and 16 females) with an average age of 45.5 years. The mean tumor volume was 10.9 cm3 (standard deviation [SD], ± 0.83), with a median tumor dose of 12 Gy (interquartile range, 11.5–12) and a mean follow-up of 34.7 months (SD, ± 23.8). Tumor response was graded as regression in 50%, stable in 44.1%, and increase or GKRS failure in 2 cases (5.8%). Treatment failure was noted in five cases (14.7%), requiring microsurgical excision and a ventriculoperitoneal shunt post-GKRS. The tumor control rate for the cohort is 85.3%, with a facial preservation rate of 96% (24/25) and hearing loss in all (5/5), while three patients developed new-onset hypoesthesia. We noted that gait ataxia and involvement of cranial nerve V or VII at initial presentation were associated with GKRS failure in univariate analysis.
Conclusion Microsurgery should remain the first-choice treatment option for large VSs. GKRS is a viable alternative with good tumor control and improved or stabilized cranial neuropathies with a low complication rate.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (National Institute of Mental Health and Neurosciences) and with the Declaration of Helsinki 1964 and its later amendments or comparable ethical standards.
Note
For this type of study, formal consent is not required. This article does not contain any studies with human participants performed by any of the authors.
Previous Presentation
This study was presented as poster at the 14th International Stereotactic Radiosurgery Society Congress 2019, Rio De Janeiro, Brazil, in June 2019.
Publikationsverlauf
Eingereicht: 04. Oktober 2020
Angenommen: 27. Februar 2021
Artikel online veröffentlicht:
23. Mai 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Boari N, Bailo M, Gagliardi F. et al. Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 2014; 121 (December, Suppl): 123-142
- 2 Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T. Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 2013; 118 (03) 557-565
- 3 Marston AP, Jacob JT, Carlson ML, Pollock BE, Driscoll CLW, Link MJ. Pretreatment growth rate as a predictor of tumor control following Gamma Knife radiosurgery for sporadic vestibular schwannoma. J Neurosurg 2017; 127 (02) 380-387
- 4 Prabhuraj AR, Yeole U, Arimappamagan A. et al. Effect of Gamma Knife radiosurgery on vestibular schwannoma with serviceable hearing: a single-center Indian study. World Neurosurg 2019; 127: e114-e123
- 5 Yang I, Sughrue ME, Han SJ. et al. A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. J Neurosurg 2010; 112 (04) 851-859
- 6 Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J. Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 2005; 57 (02) 257-265 , discussion 257–265
- 7 Klijn S, Verheul JB, Beute GN. et al. Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in the Netherlands. J Neurosurg 2016; 124 (06) 1619-1626
- 8 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102 (Suppl): 195-199
- 9 Milligan BD, Pollock BE, Foote RL, Link MJ. Long-term tumor control and cranial nerve outcomes following γ knife surgery for larger-volume vestibular schwannomas. J Neurosurg 2012; 116 (03) 598-604
- 10 Sun S, Liu A. Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma. J Neurosurg 2012; 117 (December, Suppl): 57-62
- 11 Sughrue ME, Kane AJ, Kaur R. et al. A prospective study of hearing preservation in untreated vestibular schwannomas. J Neurosurg 2011; 114 (02) 381-385
- 12 Sughrue ME, Yang I, Aranda D. et al. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 2010; 112 (01) 163-167
- 13 Ojemann RG, Montgomery WW, Weiss AD. Evaluation and surgical treatment of acoustic neuroma. N Engl J Med 1972; 287 (18) 895-899
- 14 Carlson ML, Habermann EB, Wagie AE. et al. The changing landscape of vestibular schwannoma management in the United States--a shift toward conservatism. Otolaryngol Head Neck Surg 2015; 153 (03) 440-446
- 15 Patnaik U, Prasad SC, Tutar H, Giannuzzi AL, Russo A, Sanna M. The long-term outcomes of wait-and-scan and the role of radiotherapy in the management of vestibular schwannomas. Otol Neurotol 2015; 36 (04) 638-646
- 16 Anaizi AN, DiNapoli VV, Pensak M, Theodosopoulos PV. Small vestibular schwannomas: does surgery remain a viable treatment option?. J Neurol Surg B Skull Base 2016; 77 (03) 212-218
- 17 Yang I, Aranda D, Han SJ. et al. Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: a systematic review. J Clin Neurosci 2009; 16 (06) 742-747
- 18 Bennion NR, Nowak RK, Lyden ER, Thompson RB, Li S, Lin C. Fractionated stereotactic radiation therapy for vestibular schwannomas: dosimetric factors predictive of hearing outcomes. Pract Radiat Oncol 2016; 6 (05) e155-e162
- 19 Baschnagel AM, Chen PY, Bojrab D. et al. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013; 118 (03) 571-578
- 20 Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 2011; 115 (06) 1078-1086
- 21 Rueß D, Pöhlmann L, Hellerbach A. et al. Acoustic neuroma treated with stereotactic radiosurgery: follow-up of 335 patients. World Neurosurg 2018; 116: e194-e202
- 22 Tamura M, Carron R, Yomo S. et al. Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 2009; 64 (02) 289-296 , discussion 296
- 23 Yomo S, Carron R, Thomassin J-M, Roche P-H, Régis J. Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma. J Neurosurg 2012; 117 (05) 877-885
- 24 Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD. Gamma knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery 2009; 65 (02) 294-300 , discussion 300–301
- 25 Yang I, Sughrue ME, Han SJ. et al. Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery. J Neurooncol 2009; 93 (01) 41-48
- 26 van de Langenberg R, Hanssens PEJ, Verheul JB. et al. Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 2011; 115 (05) 885-893
- 27 Wallner KE, Sheline GE, Pitts LH, Wara WM, Davis RL, Boldrey EB. Efficacy of irradiation for incompletely excised acoustic neurilemomas. J Neurosurg 1987; 67 (06) 858-863
- 28 Chung WY, Pan DHC, Lee CC. et al. Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes. J Neurosurg 2010; 113 (December, Suppl): 112-121
- 29 Huang CW, Tu HT, Chuang CY. et al. Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter. J Neurosurg 2018; 128 (05) 1380-1387
- 30 Williams BJ, Xu Z, Salvetti DJ, McNeill IT, Larner J, Sheehan JP. Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size. J Neurosurg 2013; 119 (02) 463-471
- 31 Yang HC, Kano H, Awan NR. et al. Gamma Knife radiosurgery for larger-volume vestibular schwannomas. Clinical article. J Neurosurg 2011; 114 (03) 801-807
- 32 Zeiler FA, Bigder M, Kaufmann A. et al. Gamma knife radiosurgery for large vestibular schwannomas: a Canadian experience. Can J Neurol Sci 2013; 40 (03) 342-347
- 33 Bailo M, Boari N, Franzin A. et al. Gamma Knife radiosurgery as primary treatment for large vestibular schwannomas: clinical results at long-term follow-up in a series of 59 patients. World Neurosurg 2016; 95: 487-501
- 34 Litvack ZN, Norén G, Chougule PB, Zheng Z. Preservation of functional hearing after gamma knife surgery for vestibular schwannoma. Neurosurg Focus 2003; 14 (05) e3
- 35 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112 (04) 860-867
- 36 Zhang X, Fei Z, Chen Y-J. et al. Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach. J Clin Neurosci 2005; 12 (04) 405-408
- 37 Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 2003; 59 (04) 283-289 , discussion 289–291
- 38 Park C-K, Jung H-W, Kim JE, Son Y-J, Paek SH, Kim DG. Therapeutic strategy for large vestibular schwannomas. J Neurooncol 2006; 77 (02) 167-171
- 39 Roland Jr JT, Fishman AJ, Golfinos JG, Cohen N, Alexiades G, Jackman AH. Cranial nerve preservation in surgery for large acoustic neuromas. Skull Base 2004; 14 (02) 85-90 , discussion 90–91
- 40 Mezey G, Cahill J, Rowe JG. et al. A retrospective analysis of the role of single-session gamma knife stereotactic radiosurgery in sporadic vestibular schwannomas with tumor volumes greater than 10 cm3: is it worth stretching the boundaries?. Stereotact Funct Neurosurg 2020; 98 (02) 85-94
- 41 Gurgel RK, Dogru S, Amdur RL, Monfared A. Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?. Neurosurg Focus 2012; 33 (03) E16
- 42 Iwai Y, Yamanaka K, Yamagata K, Yasui T. Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings. Neurosurgery 2007; 60 (02, Suppl 1): discussion ONS82 ONS75-ONS82
- 43 Di Maio S, Malebranche AD, Westerberg B, Akagami R. Hearing preservation after microsurgical resection of large vestibular schwannomas. Neurosurgery 2011; 68 (03) 632-640 , discussion 640
- 44 Raftopoulos C, Abu Serieh B, Duprez T, Docquier MA, Guérit JM. Microsurgical results with large vestibular schwannomas with preservation of facial and cochlear nerve function as the primary aim. Acta Neurochir (Wien) 2005; 147 (07) 697-706 , discussion 706
- 45 Mindermann T, Schlegel I. How to distinguish tumor growth from transient expansion of vestibular schwannomas following Gamma Knife radiosurgery. Acta Neurochir (Wien) 2014; 156 (06) 1121-1123
- 46 Rowe JG, Radatz MWR, Walton L, Hampshire A, Seaman S, Kemeny AA. Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas. J Neurol Neurosurg Psychiatry 2003; 74 (11) 1536-1542
- 47 Inoue HK, Nishi H, Shibazaki T, Ono N. Hearing preservation after radiosurgery combined with or without microsurgery for large vestibular schwannomas: preliminary results. In: Kondziolka D. ed. Radiosurgery. Vol. 5. Basel: Karger; 2004: 107-114
- 48 Inoue HK. Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation. J Neurosurg 2005; 102 (Suppl): 111-113
- 49 Wang EM, Pan L, Wang BJ. et al. Gamma knife for elderly patients with large vestibular schwannomas: 11-year follow-up [in Chinese]. Zhonghua Yi Xue Za Zhi 2009; 89 (17) 1189-1191
- 50 Iorio-Morin C, AlSubaie F, Mathieu D. Safety and efficacy of gamma knife radiosurgery for the management of Koos Grade 4 vestibular schwannomas. Neurosurgery 2016; 78 (04) 521-530