Controversies in building a management algorithm for vestibular schwannomas

Doherty, Joni K.; Friedman, Rick A.

doi:10.1097/01.moo.0000244186.72645.d4

Cited by 30 publications

(22 citation statements)

References 60 publications

(40 reference statements)

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“…First, this finding is not specific to radiosurgery of NF2 patients, because earlier treatment of a smaller vestibular schwannoma, whether it is sporadic or NF2-associated, with any modalities such as radiosurgery, radiotherapy, and microsurgery generally leads to a better hearing outcome. 5,[19][20][21] Second, more data regarding this issue must be collected because the statistical power of the present study was not convincingly high. Last, the apparent benefits of early treatment may reflect a well-known bias, that is, the patients diagnosed and treated earlier only appear to do better, although the long-term outcome is in fact unchanged.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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BACKGROUND:The radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) is controversial. The authors investigated the radiologically proven tumor control rate after gamma knife radiosurgery. The factors that affect tumor control and serviceable hearing preservation were analyzed.METHODS:Thirty‐six lesions in 30 patients were included. The median lengths of the clinical and radiologic follow‐ups were 48.5 months and 36.5 months, respectively. The median tumor volume was 3.2 cm3. The mean marginal dose was 12.1 grays (Gy) (range, 8–14 Gy) at an isodose line of 50%±0.6%. The Kaplan‐Meier method and Cox proportional hazards model were used for the statistical analyses.RESULTS:The actuarial tumor control rate was 81%, 74%, and 66%, respectively, in the first, second, and fifth years. Five tumors required a salvage surgery because of tumor control failure. A low marginal dose and a young age at radiosurgery were associated with poor tumor control. Of the 16 tumors with which ipsilateral hearing was serviceable, the actuarial serviceable hearing preservation rates were 50%, 45%, and 33%, respectively, in the first, second, and fifth years. Better ipsilateral hearing (Gardner‐Robertson grade 1, compared with grade 2) at the time of radiosurgery was associated with significantly greater serviceable hearing preservation.CONCLUSIONS:Gamma knife radiosurgery for vestibular schwannomas in NF2 patients provided 5‐year tumor control in approximately two‐thirds of patients and preserved serviceable hearing in approximately one‐third. The rates of other cranial nerve deficits were low, and no secondary malignancy was observed. Radiosurgery should be included in treatment options for NF2 patients. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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“…31,32 In particular, stereotactic radiosurgery for the treatment of VS introduces radiation toxicity risks to adjacent neurologic structures and result in a functional threat to the facial nerve, hearing and balance. 14,16,17,23,27,30,[33][34][35][36][37][38][39][40][41] Hydrocephalus and other cranial neuropathies such as facial spasm have also been noted after radiosurgery for VS. 4,5,23,37,[42][43][44][45][46][47] Surgical shunting and cerebrospinal fluid diversion may be required to address the late hydrocephalus complication. 4,5,23,47,48 Despite the availability of published data that highlights the clinical, radiographic, and biological parameters when managing VS patients with radiosurgery, predicting hearing preservation after radiosurgery remains a challenge for practitioners.…”

Section: Introductionmentioning

confidence: 97%

Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

Yang

Aranda

Han

et al. 2009

Journal of Clinical Neuroscience

130

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“…In particular, radiation toxicity of neuro-anatomic structures adjacent to the tumor may develop and manifest as impaired function of the facial nerve, hearing loss, or loss of equilibrium and balance. [14,16,17,23,27,30,[34][35][36][37][38][39][40][41]. Hydrocephalus, cerebral edema, and other cranial neuropathies have also been documented after GKRS, and in some reported cases required shunting as a treatment for hydrocephalus [4,23,37,[42][43][44][45][46][47][48][49].…”

Section: Introductionmentioning

confidence: 99%

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

et al. 2009

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Objective Facial nerve preservation is a critical measure of clinical outcome after vestibular schwannoma treatment. Gamma Knife radiosurgery has evolved into a practical treatment modality for vestibular schwannoma patients, with several reported series from a variety of centers. In this study, we report the results of an objective analysis of reported facial nerve outcomes after the treatment of vestibular schwannomas with Gamma Knife radiosurgery. Materials and methods A Boolean Pub Med search of the English language literature revealed a total of 23 published studies reporting assessable and quantifiable outcome data regarding facial nerve function in 2,204 patients who were treated with Gamma Knife radiosurgery for vestibular schwannoma. Inclusion criteria for articles were: (1) Facial nerve preservation rates were reported specifically for vestibular schwannoma, (2) Facial nerve functional outcome was reported using the House-Brackmann classification (HBC) for facial nerve function, (3) Tumor size was documented, and (4) Gamma Knife radiosurgery was the only radiosurgical modality used in the report. The data were then aggregated and analyzed based on radiation doses delivered, tumor volume, and patient age. Results An overall facial nerve preservation rate of 96.2% was found after Gamma Knife radiosurgery for vestibular schwannoma in our analysis. Patients receiving less than or equal to 13 Gy of radiation at the marginal dose had a better facial nerve preservation rate than those who received higher doses (B13 Gy = 98.5% vs. [13 Gy = 94.7%, P \ 0.0001). Patients with a tumor volume less than or equal to 1.5 cm 3 also had a greater facial nerve preservation rate than patients with tumors greater than 1.5 cm 3 (B1.5 cm 3 99.5% vs. [1.5 cm 3 95.5%, P \ 0.0001). Superior facial nerve preservation was also noted in patients younger than or equal to 60 years of age (96.8 vs. 89.4%, P \ 0.0001). The average reported follow up duration in this systematic review was 54.1 ± 31.3 months. Conclusion Our analysis of case series data aggregated from multiple centers suggests that a facial nerve preservation rate of 96.2% can be expected after Gamma knife radiosurgery for vestibular schwannoma. Younger patients with smaller tumors less than 1.5 cm 3 and treated with lower doses of radiation less than 13 Gy will likely have better facial nerve preservation rates after Gamma Knife radiosurgery for vestibular schwannoma.

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Controversies in building a management algorithm for vestibular schwannomas

Abstract: The risks and benefits of each treatment option must be weighed for each patient, and management decisions regarding vestibular schwannomas should be individualized for each patient depending on tumor anatomy, patient preferences, and symptoms.

Cited by 30 publications

References 60 publications

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

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