Abstract
Up to the last decade, therapeutic options for patients with vestibular schwannomas (VS) were limited to total or subtotal excision or expectant serial observation. Stereotactic irradiation, and particularly gamma knife radiosurgery (GKR), have offered an important additional option to the overall management strategy. Clinical results, in terms both of tumor growth control (TGC) and of preserved regional cranial nerve function, have increasingly validated this approach in properly selected indications for either primary or recurrent tumors. Indeed, using current neuroradiological techniques (MRI-CT fusion algorithms) as well as newer radiodosimetry programs and reduced dosages, the reported achievable TGC rate actually exceeds 90% in mid-term follow-up (5 years), whereas the relevance of radio- induced cranial neuropathy has been minimized: facial impairment incidence lower than 3%, with hearing function (Gardner-Robertson [G-R] 1-2) pre- served in over 60% of the patients. Our experience, in a series of 170 treated VS (9.4% NeuroFibromatosis type 2, or NF2) further confirms these data: the group of évaluable cases (112 patients with over 4 years of mean follow-up) shows an overall TGC rate of 93%, with an extremely low incidence of facial impairment (2.7%) and hearing preservation in 66% (G-R 1-2). However, long-term fullow-up results in large series of patients treated by contempo- rary GKR techniques are not yet available: with lowering treatment dosages, surviving tumor cells might sustain a delayed regrowth, eventually decreas- ing TGC rates. To date, GKR may be advocated for small-to-medium-sized VS, with negative cranial nerve staging, absent or minimal hearing deficit, and in several cases with major surgical contraindications or in patients refusing microsurgery. Furthermore, it is worth stressing that particularly for elderly patients with larger schwannomas and for NF2 patients, an integrated program including both GKR and microsurgery should always be considered.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Deen HG, Ebersold MJ, Harner SG, et al (1996) Conservative management of acoustic neuroma: an outcome study. Neurosurgery 39:260–266
Bederson JB, von Ammon K, Wichmann WW, et al (1991) Conservative treatment of patients with acoustic tumors. Neurosurgery 28:646–651
Lunsford LD, Linskey ME (1992) Stereotactic radiosurgery in the treatment of patients with acoustic tumors. Otolaryngol Head Neck Surg 25:471–491
Shetter AG (1997) Gamma knife radiosurgery for the treatment of acoustic neuromas. BNI Q 13:30–36
Gardner G, Moretz WH, Robertson JH, et al (1986) Neurosurgical management of small and intracanalicular acoustic tumors. Otolaryngol Head Neck Surg 94:328–333
Linskey ME, Lunsford LD, Flickinger JC (1992) Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors. Neurosurgery 31:829–839
Nedzelski JM, Schessel DA, Pfeiderer A, et al (1992) The natural history of acoustic neuromas and its role in non invasive management. In: Tos M, Thomsen J (eds) Acoustic neuroma: proceedings of the first international conference on acoustic neuromas. Copenhagen, Denmark, August 25-29, 1991. Kugler, Amsterdam, pp 149–158
Bertalanffy A, Dietrich W, Aichholzer M, et al (2001) Gamma knife radiosurgery of acoustic neurinomas. Acta Neurochir (Wien) 143:689–695
Flickinger JC, Kondziolka D, Niranjan A, et al (2001) Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experence using current methods. J Neurosurg 94: 1–6
Linskey ME (2000) Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate. J Neurosurg 93:90–95
Kondziolka D, Lunsford LD, Flickinger JC (2000) Gamma knife radiosurgery for vestibular schwannomas. Neurosurg Clin North Am 11:651–658
Linskey ME, Martinez AS, Kondziolka D, et al (1993) The radiobiology of human acoustic schwannoma xenografts after stereotactic radiosurgery, evaluated in the subrenal capsule of athymic mice. J Neurosurg 78:645–653
Anniko M, Arndt J, Norèn G (1981) The human acoustic neuroma in organ culture. Acta Otolaryngol 91:223–225
Linskey ME, Lunsford LD, Flickinger JC (1991) Neuroimaging of acoustic nerve tumors after stereotaxic radiosurgery. AJNR 12:1165–1175
Norèn G, Hirsch A, Mosskin M (1993) Long term efficacy of gamma knife radiosurgery in vestibular schwannomas (abstract). Acta Neurochir (Wien) 122:164
Linskey ME, Flickinger JC, Lunsford LD (1993) Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor, stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 25:227–233
Foote KD, Friedman WA, Buatti JM, et al (2001) Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 95:440–449
Pollock BE, Lunsford LD, Kondziolka D, et al (1998) Vestibular schwannoma management. Part II—Failed radiosurgery and the role of delayed microsurgery. J Neurosurg 89:949–955
Roche PH, Regis J, Pellet W, et al (2000) Neurofibromatosis type 2—preliminary results of gamma knife radiosurgery of vestibular schwannomas. Neurochirurgie 46:339–353
Kida Y, Kobayashi T, Tanaka T, et al (2000) Radiosurgery for bilateral neurinomas associated with neurofibromatosis type 2. Surg Neurol 53:383–389
Noren G (1998) Long term complication following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70(suppl 1):65–73
Hanabusa K, Marikawa A, Murata T, et al (2001) Acoustic neuroma with malignant transformation. J Neurosurg 95:518–521
Thomsen J, Mirz F, Wetke R (2000) Intracranial sarcoma in a patient with neurofibromatosis type-2 treated with gamma knife radiosurgery for vestibular schwannoma. Am J Otol 21:364–370
Van Roijen N, Nijs HGT, Avezaat CJJ, et al (1997) Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma. Acta Neurochir (Wien) 139:942–948
Hudgins WR (1994) Patients’ attitude about outcomes and the role of gamma knife radiosurgery in the treatment of vestibular schwannomas. Neurosurgery 34:459–465
Pollock BE, Lunsford LD, Kondziolka D, et al (1995) Outcome analysis of acoustic neuroma management: a comparison of microsugery and stereotactic radiosurgery. Neurosurgery 36:215–229
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2003 Springer Japan
About this paper
Cite this paper
Gerosa, M., Nicolato, A., Foroni, R., Bricolo, A. (2003). Gamma Knife Radiosurgery in Vestibular Schwannomas: Clinical and Radiological Impact on the Tumor Course. In: Kanzaki, J., Tos, M., Sanna, M., Moffat, D.A., Kunihiro, T., Inoue, Y. (eds) Acoustic Neuroma. Keio University International Symposia for Life Sciences and Medicine, vol 10. Springer, Tokyo. https://doi.org/10.1007/978-4-431-53942-1_23
Download citation
DOI: https://doi.org/10.1007/978-4-431-53942-1_23
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-67960-8
Online ISBN: 978-4-431-53942-1
eBook Packages: Springer Book Archive