Gamma Knife radiosurgery for intravestibular and intracochlear schwannomas
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Schwannomas of the VIIIth cranial nerve are benign tumours, with vast majority occurring in vestibular division. Rarely, they can also arise from distal branches of cochlear, superior or inferior vestibular. We review our experience with Gamma Knife radiosurgery (GKR), as first intention treatment for intracochlear (ICS) and intravestibular (IVS) schwannomas.
A total number of five patients were analysed, treated over 8 years, between June 2010 and September 2018, with Leksell Gamma Knife Perfexion or Icon (Elekta Instruments, AB, Sweden). The marginal dose prescribed was 12 Gy at a mean prescription isodose line of 61.4% (range 50–70). Clinical evaluation included auditory and facial function.
The mean age was 49.9 (range 34–63). The mean follow-up period was 52.8 months (range 12–84). The mean target volume (TV) was 0.087 ml (range 0.014–0.281). The mean maximal dose received by the cochlea was 11.2 Gy (range 2.6–20.3). The mean marginal dose received by the vestibule (e.g. utricula) was 14.2 Gy (range 3.8–17.5). No patient experienced an acute or subacute clinical adverse radiation effect after GKR. Four cases had overall symptom stability. In one patient (1/5), the vertigo, which was the main clinical complain, disappeared 1 year after GKR. However, it reappeared 3 years later, with same pretherapeutic characteristics and is currently fluctuating. One patient experienced hearing decrease after GKR, during the first 12 months. This case received 11.2 Gy to the cochlea. Follow-up MRI course showed a decrease in size in four patients, and stability in one.
Gamma Knife radiosurgery is a valuable first intention treatment for ICS or IVS, in selected cases. Special attention should be paid for the dose delivered to the cochlea and the vestibular apparatus. Acute and subacute clinical effects are exceptional, while tumour control was achieved in all cases in our small series.
KeywordsSchwannoma Intracochlear Intravestibular Radiosurgery Gamma Knife
This study was funded by Lausanne University Hospital.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
- 8.Hayashi M, Chernov M, Tamura N, Izawa M, Muragaki Y, Iseki H, Okada Y, Takakura K (2011) Gamma knife robotic microradiosurgery for benign skull base meningiomas: tumor shrinkage may depend on the amount of radiation energy delivered per lesion volume (unit energy). Stereotact Funct Neurosurg 89:6–16CrossRefGoogle Scholar
- 10.Hoshino T, Ishii D (1972) Intralabyrinthine neurilemmoma. Histopathol Rep ORL 34:117–123Google Scholar
- 13.Massager N, Drogba L, Delbrouck C, Benmebarek N, Desmedt F, Devriendt D (2011) Gamma knife radiosurgery for intralabyrinthine schwannomas. J Radiosurg SBRT 1:237–245Google Scholar
- 20.Tsao MN, Sahgal A, Xu W, De Salles A, Hayashi M, Levivier M, Ma L, Martinez R, Regis J, Ryu S, Slotman BJ, Paddick I (2017) Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) practice guideline. J Radiosurg SBRT 5:5–24Google Scholar
- 21.Tuleasca C, George M, Faouzi M, Schiappacasse L, Leroy HA, Zeverino M, Daniel RT, Maire R, Levivier M (2016) Acute clinical adverse radiation effects after gamma knife surgery for vestibular schwannomas. J Neurosurg 125:73–82Google Scholar