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Microsurgery for Vestibular Schwannomas After Failed Radiation Treatment

  • Yoichi Nonaka
  • Takanori Fukushima
Chapter

Abstract

Currently, there are three primary management strategies for small- to medium-sized vestibular schwannomas (VSs), including wait-and-scan, microsurgical resection, and radiation therapy. Numbers of patients with VS treated with stereotactic radiation therapy (SRT) have been increasing over the past two decades with the trend of less use of microsurgery. Several types of focused-beam SRT including Gamma Knife (GK), CyberKnife (CK), Novaris, and proton beam have been utilized to control the growth of VS since the early 1990s. With advances in computer technology and more accurate targeting, SRT has become widely adopted to the treatment option of VS. Despite these advances, a small percentage of VS grow after radiation treatment. However, management for these patients is still controversial. Although repeat radiation therapy is thought to carry increased adverse risk and a higher rate of secondary failure, some of the patients underwent two or more times of radiation therapy. On the other hand, surgical outcomes for VSs have improved following the progress in microsurgical techniques. In 2016, we reported our experience of surgical management for previously radiated VSs who required surgical intervention. Our findings suggested that salvage surgery for VS who fail SRT would have a higher risk of postoperative complications. In this report, we updated our surgical experience with a consecutive series of 74 cases of VSs after failed radiation treatment.

Keywords

Acoustic neuroma Radiosurgery Salvage microsurgery Stereotactic radiation therapy Vestibular schwannoma 

Abbreviations

CK

CyberKnife

CN

Cranial nerve

GTR

Gloss total resection

H-B

House-Brackmann facial nerve function grading scale

LINAC

Linear accelerator

MR-VS

Vestibular schwannoma previously treated with microsurgery and radiotherapy

NTR

Near-total resection

N-VS

Non-radiated vestibular schwannoma

R-VS

Radiated vestibular schwannoma

SRS

Stereotactic radiosurgery

SRT

Stereotactic radiotherapy

STR

Subtotal resection

VS

Vestibular schwannoma

Notes

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yoichi Nonaka
    • 1
  • Takanori Fukushima
    • 2
  1. 1.Department of NeurosurgeryTokai University School of MedicineKanagawaJapan
  2. 2.Division of NeurosurgeryDuke University Medical Center, Carolina Neuroscience InstituteRaleighUSA

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