Fractionated Stereotactic Radiosurgery for Treatment of Acoustic Neuromas

Abstract

Background: Microsurgery and single-fraction radiosurgery for acoustic neuromas are associated with high rates of control, but can result in facial palsy and trigeminal neuropathy. To reduce the morbidity of treatment for acoustic neuromas while maintaining efficacy, we explored fractionated stereotactic radiosurgery (FSR). Methods: We reviewed data for 31 acoustic neuromas in 30 patients treated with 25 Gy (linear accelerator) given in 5 consecutive daily fractions. The minimum follow-up was 6 months (6–44 months). The mean tumor volume was 1.1 cm³ (0.1–8.74 cm³). Results: All tumors remain controlled (9 smaller, 22 unchanged). No patient has experienced post-radiosurgery facial motor dysfunction. Two patients developed new trigeminal neuropathy; 2 patients with preexisting trigeminal nerve symptoms had improvement after FSR. Balance improved in 3 patients, was unchanged in 20 and worsened in 7 patients. Of the 12 patients with useful hearing (PTA ≤ 50 dB) prior to treatment, 9 patients retained useful hearing following FSR. Subjectively, of 25 patients with any hearing prior to treatment, 2 had improvement, 10 remained unchanged and 13 had worsening. Conclusions: Short course FSR for acoustic neuromas results in acceptable toxicity and may provide high control of tumors. Longer follow-up is needed to assess outcomes.

Non-audiofacial morbidity after Gamma Knife surgery for vestibular schwannoma

“…1,13,14,26,41,55,71,79,83,84 While planning is often similar to GKS, the method of immobilization is different. Rather than a frame-based approach, the position of target structure is replicated daily using customized head molds and/or face masks while obtaining regular radiographs to confirm positioning.…”

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

“…1,[11][12][13]28,39,47,55,62,63,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] The age range of patients treated with radiosurgery varied from 20 years to 73.5 years, with an average of 53.6 years (±10.7 years) and an average follow-up time of 41.2 months (±27.1 months). Similarly, the median length of follow-up in our analysis was 34.3 months.…”

Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

“…Similar results have been confirmed in other patient series. 2,6,10,15,21,29,48,49,55 Sheehan and colleagues 45 have reported excellent results using GKS in 26 patients with trigeminal schwannomas, and Hasegawa and associates 14 found similar results in 37 patients. Kida et al 18 reported a 100% tumor control rate of facial neuromas after a mean follow-up of 31 months with GKS.…”