Fractionated Stereotactic Radiotherapy in the Treatment of Vestibular Schwannoma (Acoustic Neuroma): Predicting the Risk of Hydrocephalus

Radiotherapy for benign brain tumours coming of age; example of vestibular schwannoma

“…fSRT, suitable for AN of all sizes, started later and there are few results reporting 10 year outcome [13]. The current report from Heidelberg shows identical 93% local PFS [4] similar to other published long-term results [19]. The longest experience comes from a small cohort of patients treated with conventional fractionated radiotherapy with up to 20 year follow up, with a 10 and 15 year control rate of 86% [20].…”

“…Single high doses to larger lesions can also cause imaging changes [30]. The risk of neuropathy following fractionated treatment is lower (1-3%) and the nerve dysfunction tends to be transient with no recognised imaging changes [4,13,19]. Despite the hope for lower toxicity with proton therapy, the risk of cranial nerve injury following single fraction and fractionated treatment is in the region of 7-10% [21][22][23].…”

“…The principal concern in the post-treatment period is the risk of hydrocephalus [19,34] due to transient enlargement of the tumour 6 months to 3 years after treatment [35,36] which is life threatening if not dealt with. The actuarial risk is up to 10% and is AN size related [19].…”

“…The actuarial risk is up to 10% and is AN size related [19]. It requires awareness of what may at first appear as nonspecific neurological deterioration particularly in older patients.…”

Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – Pooled results from 3 large German centers

“…Local control is comparable to RS, i.e. between 80 and 100%, and hearing preservation is high also for larger tumor volumes [13,[23][24][25][26][27][28].…”