Equivalent Efficacy and Safety of Radiosurgery for Cystic and Solid Vestibular Schwannomas: A Systematic Review

Massaad, Elie; Hamidi, Nima; Goetz, Jacalynn; Padmanaban, Varun; Mau, Christine; Tsang, Derek S.; Moraes, Fábio Ynoe de; Chung, Caroline; Zacharia, Brad E.; Mansouri, Alireza

doi:10.1016/j.wneu.2020.11.040

Cited by 5 publications

(5 citation statements)

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“…The response of the tumor to a single portion of radiosurgery was shown to be the same in cystic and solid VS by Massaad et al Having a cyst within the tumor may not enhance the likelihood of further tumor growth or the occurrence of side effects during radiosurgery. 40 Comparable to our findings, Ogino et al found no correlation between sex and cochlear dose and hearing control. While we observed no such association between age and hearing function, these authors actually found that younger age was substantially related with improved hearing control.…”

Section: Prognostic Factors Using Gamma Knife Stereotactic Radiationcontrasting

confidence: 71%

“…Pseudoprogression or temporary tumor growth, as stated by Massaad et al should always be taken into consideration. 40 As pseudoprogression often begins 6 to 9 months after radiosurgery, it is usually temporary and characterized by contrast enhancement and volume expansion. 15,29 In contrast to our findings, Varughese et al found no correlation between tumor volume and tumor pseudoprogression.…”

Section: Individuals Presented With Pseudoprogressionmentioning

confidence: 99%

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Outcomes and Prognostic Factors in the Treatment of Intracanalicular Vestibular Schwannomas Using Gamma Knife Stereotactic Radiation

Dzierzęcki

Obierzyński

Rogala

et al. 2023

Ann Otol Rhinol Laryngol

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Background: No gold standard has been developed for the therapy of intracanalicular vestibular schwannomas (IVS). Options for treatment include a conservative approach, microsurgery, or radiosurgery. Although the efficacy of these treatment has been well-documented, little is known about the determinants of outcome in IVSs following radiosurgery. Therefore, we examined the results in relation to age, gender, tumor volume, distance to fundus, microcyst existence, and radiosensitivity in this group. In addition, we investigated possible predictors of facial nerve function and hearing preservation. Methods: Ninety-four patients with unilateral IVS were included in the evaluation (52 women and 42 males). The patients were separated into younger and older age groups based on their median age (55 years). The median IVS volume was 138 mm3, microcysts were identified in 16 tumors, and 63 tumors were adjacent to the fundus. The data were analyzed using Statistica software package ver. 13.3. Results: At final follow-up, a statistically significant decrease in tumor volume and no statistically significant decline in hearing were noted, but no differences between age groups were found. The sex had no effect on overall tumor growth control, facial nerve preservation, or hearing preservation. Localization of IVS close to the fundus and the presence of tumor microcysts had no effect on the control of tumor growth, preservation of hearing, and sparing of facial nerve following radiosurgery. Cochlear dose had no influence on hearing preservation. Higher tumor volume was associated with its pseudoprogression during early follow-up and a greater risk of hearing loss. Conclusions: Age, sex, tumor volume, proximity to the fundus, and the existence of a microcyst were not predictive of radiosensitivity nor preservation of facial nerve function and hearing, based on the findings. There was no effect of cochlear dose on hearing. Initial greater tumor volume was associated with an increased probability of tumor pseudoprogression.

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Section: Prognostic Factors Using Gamma Knife Stereotactic Radiationcontrasting

confidence: 71%

Section: Individuals Presented With Pseudoprogressionmentioning

confidence: 99%

Outcomes and Prognostic Factors in the Treatment of Intracanalicular Vestibular Schwannomas Using Gamma Knife Stereotactic Radiation

Dzierzęcki

Obierzyński

Rogala

et al. 2023

Ann Otol Rhinol Laryngol

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“…In a series by Lonneville et al [27], the authors evaluated the role of PET during follow-up course, which showed a significant metabolic decrease of the tumor, further considered as TTE. Moreover, one other particular aspect is related to potential cystic components or entrapment cysts [29], the latter with much-complicated decision making, depending on the clinical context [53]. With regard to patient-related aspects, indications for additional management after initial GK might include trigeminal neuropathy (numbness, trigeminal pain, facial neuropathy), facial neuropathy (palsy, hemifacial spasm [18]), or vestibular (major imbalance).…”

Section: Discussionmentioning

confidence: 99%

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

et al. 2021

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Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SRS was 2.2% (range 1.2–3.2%, p < 0.001). The mean time between first and second SRS was 50.7 months (median 51, range 44–64). The median marginal dose prescribed at first SRS was 12 Gy (range 8–24) and at second SRS was 12 Gy (range 9.8–19). After repeat SRS, tumor stability was reported in 61/194 patients, i.e., a rate of 29.6% (range 20.2–39%, I2 = 49.1%, p < 0.001). Tumor decrease was reported in 83/194 patients, i.e., a rate of 54.4% (range 33.7–75.1%, I2 = 89.1%, p < 0.001). Tumor progression was reported in 50/188 patients, i.e., a rate of 16.1% (range 2.5–29.7%, I2 = 87.1%, p = 0.02), rarely managed surgically. New trigeminal numbness was reported in 27/170 patients, i.e., a rate of 9.9% (range 1.4–18.3%, p < 0.02). New facial nerve palsy of worsened of previous was reported in 8/183 patients, i.e., a rate of 4.3% (range 1.4–7.2%, p = 0.004). Hearing loss was reported in 12/22 patients, i.e., a rate of 54.3% (range 24.8–83.8%, I2 = 70.7%, p < 0.001). Repeat SRS after previously failed SRS for VS is associated with high tumor control rates. Cranial nerve outcomes remain favorable, particularly for facial nerve. The rate of hearing loss appears similar to the one related to first SRS.

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“…Obstructive hydrocephalus necessitating cerebrospinal uid diversion is also less common in cVS, probably because cysts conform to the contour of the surrounding neural structures rather than compressing them [2]. Regarding volumetric response, it has been shown that cVS patients demonstrate approximately 2-times more shrinkage (80.2% vs. 45.9%) compared to patients with sVS [32]. The rate of patients demonstrating shrinkage was 92.6% in our cohort and the mean volumetric reduction was 68.5%.…”

Section: Discussionmentioning

confidence: 99%

“…246 cVSs [10] and a systematic review [32], which included both sVS (n = 1085) and cVS (n = 273) patients with or without prior therapy, indicate that GKRS has similar e cacy in patients with cVS as it does in patients with sVS.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

et al. 2022

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Background: Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the e cacy and safety of upfront SRS for large cVSs.Methods: The authors reviewed the data of 54 patients who received upfront, single-session GKRS with a diagnosis of large cVS (>4 cm3). Patients with neuro bromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded.Results: Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were KOOS grade IV (66.7%), and the most prevalent cyst pattern was "mixed pattern of small and big cysts" (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1-147 months). At GKRS, the median cVS volume was 6.95 cm 3 (range, 4.1-22 cm 3 ). The median marginal dose was 12 Gy (range, 10-12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24-169 months) and 94.9 ± 45.41 months (range, 24-175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n=50), tumor volume remained stable in 5.6% of patients (n=3), and tumor growth occurred in 1.9 percent of patients (n=1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume signi cantly decreased to 2.35 cm3 (p<0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, "multiple small thick-walled cyst pattern" and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I-II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n=1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus.Conclusions: Contrary to what was believed, our ndings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs.

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Equivalent Efficacy and Safety of Radiosurgery for Cystic and Solid Vestibular Schwannomas: A Systematic Review

Cited by 5 publications

References 40 publications

Outcomes and Prognostic Factors in the Treatment of Intracanalicular Vestibular Schwannomas Using Gamma Knife Stereotactic Radiation

Outcomes and Prognostic Factors in the Treatment of Intracanalicular Vestibular Schwannomas Using Gamma Knife Stereotactic Radiation

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

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