Radiation Therapy and Radiosurgery for Vestibular Schwannomas:

Link, Michael J.; Driscoll, Colin L. W.; Foote, Robert L.; Pollock, Bruce E.

doi:10.1016/j.otc.2011.12.006

Cited by 32 publications

(18 citation statements)

References 51 publications

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“…Delsanti and Régis 4 described their experience with stereotactic radiosurgery in the treatment of 54 CVS cases. Their failure rate, defined as the need for a second procedure, was 6.4%, almost 3-fold greater than that reported for solid VS. 15 In our series, only 1 patient was treated with radiosurgery (5040 cGy in the form of intensity-modulated radiation therapy). As can be seen in Fig.…”

Section: Discussionmentioning

confidence: 85%

Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature

Yashar

Zada²,

Harris³

et al. 2012

FOC

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Object Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve sheath, representing approximately 6%–8% of all newly diagnosed brain tumors, with an annual incidence of 2000–2500 cases in the US. Although most of these lesions are solid, cystic vestibular schwannomas (CVSs) compose 4%–20% of all VSs and are commonly larger at the time of presentation. The authors present their experience with the operative management of CVSs, including surgical approach, extent of resection, and postoperative facial nerve outcomes. The literature pertaining to clinical and histopathological differences between CVSs and their solid counterparts is reviewed. Methods The University of Southern California Department of Neurosurgery database was retrospectively reviewed to identify patients who had undergone resection of a VS between 2000 and 2010. One hundred seventy-nine patients with VS were identified. Patients with CVSs were the subject of the present analysis. Diagnosis of a CVS was made based on MRI findings. Clinical and neuroimaging data, including pre- and postoperative assessments and operative notes, were collected and reviewed. Results Twenty-three patients, 14 men (61%) and 9 women (39%), underwent 24 operations for CVSs. These patients composed 12.8% of all cases of VS. Patient ages ranged from 28 to 78 years (mean 55 years), and the mean maximal tumor diameter was 3.6 cm (range 2.0–4.0 cm). Patients most frequently presented with headache, hearing loss, vertigo, and dizziness. Preoperative facial numbness was reported in 44% of patients. Among the 24 cases, 13 were treated with retrosigmoid craniotomy and 11 via a translabyrinthine approach. Complete resection was achieved in 11 patients (48%), subtotal resection (STR) in 8 patients (35%), and near-total resection (NTR) in 4 patients (17%). Facial nerve outcomes were available in all except one case. Good facial nerve outcomes (House-Brackmann [HB] Grades I–III) were achieved in 82% of the patients who had undergone either NTR or STR, as compared with 73% of patients who had undergone gross-total resection (GTR; p > 0.05, Fisher exact test). In comparison, 83% of patients with solid VSs had a good HB grade (p = 0.38, Fisher exact test), although this finding did not reach statistical significance. Complications included wound infection (2 patients), delayed CSF leakage (1 patient), and a delayed temporal encephalocele following a translabyrinthine approach and requiring surgical repair (1 patient). Conclusions Cystic vestibular schwannoma represents a clinical and surgical entity separate from its solid counterpart, as demonstrated by its more rapid clinical course and early surgical outcomes. Facial nerve grades may correlate with the degree of tumor resection, trending toward poorer grades with more significant resections. Although GTR is recommended whenever possible, performing an STR when facial nerve preservation is in jeopardy to improve facial nerve outcomes is the preferred strategy at the authors' institution.

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Section: Discussionmentioning

confidence: 85%

Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature

Yashar

Zada²,

Harris³

et al. 2012

FOC

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“…Initially, VS were treated with higher doses (16-20 Gy) of radiation, and most tumors were found to decrease in size. However, higher rates of hearing loss, FN, and trigeminal nerve neuropathies led to decreased doses for single (12)(13)(14) or hypofractionated (18-21 Gy) treatment paradigms [41].…”

Section: Stereotactic Radiationmentioning

confidence: 99%

“…Given the bulk of the tumor being isolated to the IAC with minimal CPA extension, the hearing ablative, translabyrinthine approach is most ideal as it will allow for complete tumor extirpation, facial nerve preservation, and no brain retraction known concern. While radiation of tumors in the NF2 population is appealing [41], STR in this population may be associated with lower tumor control rates and higher rates of malignant transformation [45].…”

Section: Indications For Stereotactic Radiation Treatmentmentioning

confidence: 99%

“…The FN and trigeminal nerve (up to 3 %) [29,33,41,52] are most susceptible to injury with STR. The incidence of injury has decreased secondary to lower and more accurate radiation dosing.…”

Section: Complicationsmentioning

confidence: 99%

“…The incidence of injury has decreased secondary to lower and more accurate radiation dosing. Nonetheless, facial paresis continues to occur (up to 4 %) [29,41,50], is typically temporary and may improve with steroids, yet can be permanent (1.6 %) [33,41] and is more likely when treating larger tumors [43] or with use of higher radiation doses (13 Gy) [52]. Post-radiation dysfunction of the Fig.…”

Section: Complicationsmentioning

confidence: 99%

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Vestibular Schwannomas: Surgical and Nonsurgical Management

2015

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Management options of vestibular schwannomas continue to evolve as surgical, radiation, and radiologic imaging techniques and technology change and improve over time. Currently, three options for these tumors exist and include primary surgical extirpation, stereotactic radiation, and observation with serial imaging. Skull base surgeons are charged with providing the patient with a comprehensive discussion of each option based on the inherit risks and benefits of each option to craft a management plan based on numerous factors that include age, tumor location, and size, hearing level at presentation and any medical comorbidities that may influence functional outcomes and quality of life. The purpose of this article was to review the surgical and non-surgical approaches to tumor management highlighting the risks and benefits and ongoing controversies between modalities regarding optimal functional outcomes. A particular emphasis is placed on hearing preservation and facial nerve function after treatment.

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