Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Koos, W. Th.; Day, John D.; Matula, Ch.; Levy, Doron

doi:10.3171/jns.1998.88.3.0506

Cited by 294 publications

(187 citation statements)

References 46 publications

(18 reference statements)

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“…The mean age was 47.5 years (range, 17-76 years), and the mean tumor volume was 1353 mm 3 (range, 64-4640 mm 3 ). According to the Koos classification (17), the lesion treated was Stage I in 8 cases, Stage II in 21 cases, Stage III in 43 cases, and Stage IV in 2 cases. The initial symptom was hearing decrease in 29 patients, tinnitus in 22 patients, unsteadiness in 9 patients, and vertigo in 4 patients.…”

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confidence: 99%

Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas Presenting With High-Level Hearing

et al. 2009

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Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas Presenting With High-Level Hearing

et al. 2009

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“…2,12 Microsurgery is the first option if the tumor is large or symptoms of mass effect and hydrocephalus are present. 4,21,35,36 SRS is generally used to treat small-to medium-sized VSs but has also demonstrated satisfactory results with larger lesions as well. 20,30,31,[39][40][41]45 Nevertheless, the latter represent a challenge for both surgeons and radiosurgeons, because a direct correlation between tumor size and facial nerve damage does exist in the postoperative period.…”

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confidence: 99%

“…All tumors were Grade 4 according to the Koos classification. 21 Volumes were calculated using the MultiPlan (Accuray) planning system during treatment or using the treatment planning records; on MR or CT images, the formula (D1 × D2 × D3)/2 was adopted, where D1 was the major anteroposterior axis parallel to the petrous bone, D2 was the major axis orthogonal to D1, and D3 was the major craniocaudal axis.…”

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Multisession stereotactic radiosurgery for large vestibular schwannomas

Casentini

Fornezza

Perini

et al. 2015

JNS

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OBJECT Microsurgery is not the only option for larger vestibular schwannomas (VSs); recent reviews have confirmed the feasibility and efficacy of radiosurgery for larger VSs. This study illustrates the outcomes of a series of large VSs after multisession stereotactic radiosurgery (SRS). METHODS A series of 33 VSs larger than 8 cm3 (range 8–24 cm3, mean 11 cm3, median 9.4 cm3) were treated using the CyberKnife from 2003 to 2011 with the multisession SRS technique in 2–5 fractions (14–19.5 Gy). Five patients had undergone surgical removal and 5 had ventriculoperitoneal shunts. Nine patients were eligible for but refused surgery. Twelve patients were older than 70 years and 5 were younger than 40 years. Two female patients had neurofibromatosis. RESULTS The follow-up period ranged from 12 to 111 months (median 48 months); radiological growth control was achieved in 94% of cases: 19 tumors (58%) displayed no size variation or reduction in tumor diameter; 12 (36%), after a transient enlargement, presented with arrested growth or shrinkage. Seven patients had a volume reduction of more than 50%. Two patients (6%) needed debulking and 2 were treated with ventriculoperitoneal shunts. Actuarial progressionfree survival rates at 1 year and 5 years were 97% and 83%, respectively. Hearing was retained in 7 of the 8 patients with serviceable baseline hearing. Adverse events were limited to 1 case each of vertigo, tongue paresthesia, and trigeminal neuralgia. CONCLUSIONS The good control rate obtained with multisession SRS deepens the controversy of the radiobiology of VSs and may extend the indication of radiation therapy (fractionated or SRS) for large VSs to include patients without symptoms of mass effect. The limited number of cases and short follow-up period do not provide sufficient support for widespread application of multisession SRS in young patients. Further studies with multisession SRS are warranted.

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“…Koos et al 50 reported remarkable results in their group of patients with small VSs treated by microsurgery. Good hearing (using the 50/50 rule) was maintained in 100% of patients with Koos Stage 1 tumors and in 87% of patients with Koos Stage 2 tumors.…”

Section: Chances Of Hearing Preservation After Srsmentioning

confidence: 97%

An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

FOC

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Cited by 294 publications

References 46 publications

Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas Presenting With High-Level Hearing

Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas Presenting With High-Level Hearing

Multisession stereotactic radiosurgery for large vestibular schwannomas

An update on unilateral sporadic small vestibular schwannoma

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