Linear accelerator radiosurgery for vestibular schwannoma

Spiegelmann, Roberto; Lidar, Zvi; Gofman, Jana; Alezra, D.; Hadani, Moshe; Pfeffer, Raphael

doi:10.3171/jns.2001.94.1.0007

Cited by 115 publications

(59 citation statements)

References 20 publications

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“…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.…”

Section: Schwannomassupporting

confidence: 51%

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

Johnson

Loredo

Slater

2008

FOC

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✓ Historically, radiation therapy has been used extensively in the treatment of malignant and aggressive intracranial tumors, and the importance of its role has been repeatedly verified by prolonged patient survival rates and increased tumor control. As more modern capabilities are employed in surgery and radiotherapy, attention is being directed to the utility of radiation as either primary or secondary treatment of benign tumors. Specifically, primary treatment encompasses irradiation of small benign tumors without biopsy confirmation of tumor type; secondary treatment involves postoperative radiation therapy, with the possibility that less-aggressive tumor resection may be performed in areas that have a higher probability of resultant neurological deficit. Current literature suggests that this is not only a possible treatment strategy, but that it may be superior to more radical resection in some cases, for example, in vestibular schwannomas and meningiomas. This article provides an overview of factors to consider in the use of radiation therapy and reviews the relationships between radiation and surgery, notably the unique complementary role each plays in the treatment of benign intracranial tumors.

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Section: Schwannomassupporting

confidence: 51%

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

Johnson

Loredo

Slater

2008

FOC

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“…Since there was a high risk of cranial neuropathy, these authors did not recommend using only CT-based planning and high prescription doses. Spiegelmann et al 56 reported their results of LINAC radiosurgery for 44 patients with vestibular schwannomas. After a mean follow-up period of 32 months (range 12-60 months), 98% of the tumors were controlled.…”

Section: Linear Accelerator Radiosurgery: Clinical Resultsmentioning

confidence: 99%

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

Kondziolka

Mousavi

Kano

et al. 2012

FOC

132

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Object Management recommendations for patients with smaller-volume or newly diagnosed vestibular schwannomas (< 4 cm3) need to be based on an understanding of the anticipated natural history of the tumor and the side effects it produces. The natural history can then be compared with the risks and benefits of therapeutic intervention using a minimally invasive strategy such as stereotactic radiosurgery (SRS). Methods The authors reviewed the emerging literature stemming from recent recommendations to “wait and scan” (observation) and compared this strategy with published outcomes after early intervention using SRS or results from matched cohort studies of resection and SRS. Results Various retrospective studies indicate that vestibular schwannomas grow at a rate of 0–3.9 mm per year and double in volume between 1.65 and 4.4 years. Stereotactic radiosurgery arrests growth in up to 98% of patients when studied at intervals of 10–15 years. Most patients who select “wait and scan” note gradually decreasing hearing function leading to the loss of useful hearing by 5 years. In contrast, current studies indicate that 3–5 years after Gamma Knife surgery, 61%–80% of patients maintain useful hearing (speech discrimination score > 50%, pure tone average < 50). Conclusions Based on published data on both volume and hearing preservation for both strategies, the authors devised a management recommendation for patients with small vestibular schwannomas. When resection is not chosen by the patient, the authors believe that early SRS intervention, in contrast to observation, results in long-term tumor control and improved rates of hearing preservation.

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“…7,9,20,23,26,32,35,40,47 However, SRS options are still difficult to assess, due to highly inconsistent reporting of hearing results. Treatment with SRS carries a risk of direct axonal radionecrosis as well as microvascular degeneration, both of which can lead to delayed hearing loss.…”

Section: Discussionmentioning

confidence: 99%

Durability of hearing preservation after microsurgical treatment of vestibular schwannoma using the middle cranial fossa approach

Wang

Chinn

Than³

et al. 2013

JNS

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V estibular schwannomas are relatively rare, accounting for approximately 8% of all intracranial tumors. 50 They arise from the vestibular portions of the eighth cranial nerve, which runs in conjunction with the seventh cranial nerve through the CPA into the IAC, where the Obersteiner-Redlich transition zone occurs. 21 Approximately 5% of cases are associated with neurofibromatosis Type 2. 51 The most common presentation is progressive unilateral hearing loss. In a natural history study by Stangerup et al., 48 growth after diagnosis of intracanalicular VS was observed in 64% of cases in the 1st year, in an additional 23% by the 2nd year, and in 5% more by the 3rd year.The widespread use of MRI has resulted in earlier diagnosis of VS, such that patients with very small lesions and excellent residual hearing in the involved ear often present for treatment consideration. Hearing preservation is a reasonable primary goal of management in such cases. Object. The middle cranial fossa (MCF) approach is a microsurgical technique described as a primary option in the treatment of small, intracanalicular schwannomas involving the eighth cranial nerve. Excellent rates of complete tumor resection, hearing preservation, preservation of facial nerve function, and low complication rates have been reproduced using this technique. However, the durability of hearing preservation attained using the various treatment options has not been adequately assessed. The purpose of this study was to evaluate the durability of long-term hearing preservation in patients with vestibular schwannoma (VS) treated via the MCF approach. The authors hypothesize that hearing preservation in these patients will prove to be durable years after treatment in a high percentage of cases.Methods. Retrospective medical chart review was performed in 103 consecutive patients undergoing resection of VS via a modified MCF approach between 1999 and 2008. Patients in whom surgical goals were gross-total resection and hearing preservation were included. Preoperative and postoperative hearing assessment was performed using standard audiometric testing, and classified according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines as a primary outcome measure. Outcomes and neurological complications initially, and at 1, 3, and 5 years following operation were analyzed.Results. Initial hearing preservation rates were in keeping with the best previously published results. At initial postoperative audiometric follow-up, of the patients presenting with Class A hearing, 67% remained Class A, 17% were Class B, 1% were Class C, and 15% were Class D. Of patients presenting with Class B hearing, 24% were Class A, 53% remained Class B, 6% were Class C, and 18% were Class D. Of patients presenting with Class C hearing, 100% remained Class C.To assess the durability of hearing preservation in our patients, the authors evaluated hearing function at regular intervals after the initial postoperative audiometric follow-up. Audiometric data were available ...

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Linear accelerator radiosurgery for vestibular schwannoma

Abstract: Single-isocenter LINAC radiosurgery proved to be an effective treatment for acoustic neuromas in this series, with results that were comparable with those reported for gamma knife radiosurgery and multiple isocenters.

Cited by 115 publications

References 20 publications

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

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

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

Durability of hearing preservation after microsurgical treatment of vestibular schwannoma using the middle cranial fossa approach

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