Fractionated stereotactic radiotherapy for acoustic neuroma

Koh, Eng‐Siew; Millar, Barbara‐Ann; Ménard, Cynthia; Michaels, Howard B.; Heydarian, M.; Ladak, S.; McKinnon, S.; Rutka, John; Guha, Abhijit; Pond, Gregory R.; Laperrière, Normand

doi:10.1002/cncr.22499

Cited by 71 publications

(3 citation statements)

References 43 publications

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“…Comparing these results, it is evident that continuous experience in VS surgery and the consistent use of intraoperative monitoring can result in hearing preservation rates that are better or equal than those found in alternative treatment options like gamma-knife surgery [40][41][42][43][44] or the wait-and-scan option [24,25].…”

Section: Discussionmentioning

confidence: 85%

Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Scheich

Ginzkey

Harnisch

et al. 2011

Eur Arch Otorhinolaryngol

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The aim of this study was to analyze the results of microsurgery in vestibular schwannomas (VS) with assistance of a flexible CO(2) laser fiber (Omniguide(®)) using the middle cranial fossa (MCF) approach. For that purpose we performed a prospective non-randomized clinical trial. In 20 consecutive patients suffering from VS and elected for microsurgery via the MCF approach, tumor resection was performed with the aid of the flexible CO(2) laser ("laser group", LG). Twenty patients with similar tumor volume and pre-operative hearing status out of a cohort of 76 patients previously treated by the same surgeon without laser were used as comparison group ("conventional group", CG) (matched-pair-technique). Facial weakness (House-Brackmann (HB) 2-4) was seen in early postoperative (p.o.) days in six patients in each group and all recovered completely by 3 months p.o., except one patient with HB 2 in CG. Facial nerve preservation rate (HB 1 + 2) was 100% in both groups. Hearing preservation rate (Gardner/Robertson class 1 + 2 or AAO-HNS A + B, pre- and postoperatively) was 72% in LG and 82% in CG, without significant difference. Overall time from incision to skin suture was 157 min (SD 55.9) in CG and 160 min (SD 39.7) in LG. Tumor preparation time was 23.2 min (SD 19.7) in CG and 36.1 min (SD 33.8) in LG. The use of a handheld flexible CO(2) laser fiber in VS-microsurgery is safe and subjectively facilitates tumor resection especially in "difficult" (e.g., highly vascularized) tumors. However, in this limited prospective trial the excellent functional outcome following conventional microsurgery could not be further improved, nor the surgical time reduced by means of the non-contact laser-tool. Focusing the use of the flexible CO(2) laser on "difficult" tumors may lead to different results in future.

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Section: Discussionmentioning

confidence: 85%

Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Scheich

Ginzkey

Harnisch

et al. 2011

Eur Arch Otorhinolaryngol

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“…Both of these techniques are known to be highly efficacious, with most studies estimating a tumor control rate above 95% (10–12). We report tumor control of unilateral tumors with FSRT.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Kapoor

Batra

Carson

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radio-therapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm3 were 18.02 times more likely to progress than those with tumor volumes of 1 cm3 or greater (odds ratio, 18.02; 95% confidence interval, 4.25–76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the “no salvage surgery needed” and “no additional treatment needed” criteria for treatment success need to be complemented by the radiologic data.

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“…Radiation therapy, either stereotactic radiosurgery or external beam radiotherapy, can be used as primary, adjuvant or a salvage treatment strategy for localized disease with excellent local control [ 4 – 6 ] [16,18,19]. Local control is 98%, 88%, and 73% of intracranial hemangioblastomas at 1, 2, and 6 years, respectively, with marginal dose and fractions ranging from 10–32 Gy and 1–10 fractions, respectively [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Hemangioblastoma with late leptomeningeal metastasis: a case report

et al. 2023

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Background Hemangioblastoma of the central nervous system is an uncommon benign neoplasm, with about 25% of cases in patients with von Hippel–Lindau disease. The incidence of metastasis is rare, particularly in patients without von Hippel–Lindau disease. We report a case of hemangioblastoma with leptomeningeal dissemination as a late recurrence. Case presentation A 65-year-old Caucasian man with a history of World Health Organization grade I hemangioblastoma of the cerebellar vermis underwent gross total resection in 1997. In early 2018, he developed intracranial recurrences with diffuse leptomeningeal disease of the entire spine. The patient underwent resection of intracranial recurrence, followed by palliative craniospinal irradiation. The disease progressed quickly, and he died 8 months after recurrence. Conclusions Despite a benign pathology, hemangioblastoma has a low risk of metastasis. The outcome for hemangioblastoma patients with metastasis is poor. Multidisciplinary care for patients with metastatic hemangioblastoma warrants further investigation, and an effective systemic option is urgently needed. Regular lifelong follow-up of at-risk patients is recommended.

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Fractionated stereotactic radiotherapy for acoustic neuroma

Cited by 71 publications

References 43 publications

Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach

Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Hemangioblastoma with late leptomeningeal metastasis: a case report

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