Stereotactic Radiation Techniques in the Treatment of Acoustic Schwannomas

Abram, Stephen E.; Rosenblatt, Paul; Holcomb, Stephen

doi:10.1016/j.otc.2007.04.001

Cited by 13 publications

(5 citation statements)

References 28 publications

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“…A review of available evidence suggests that SRT may offer even better hearing preservation and lower cranial nerve toxicity than SRS based on biologic models[20]. This includes similar tumour control rates with hearing preservation greater than 90%.…”

Section: Case Presentationmentioning

confidence: 99%

Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

et al. 2009

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Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

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Section: Case Presentationmentioning

confidence: 99%

Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

et al. 2009

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“…Hence, sparing of mesial temporal lobe may preserve long-term neurocognitive function. GammaKnife is the gold-standard RS system [8,9]. In the last few decades, LA-based RS systems such as BrainLAB have been used [24].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with large AN (size [2.5 cm), with gross impairment of or no hearing function and patients with brainstem compression are treated with surgical resection [3]. On the other hand, small ANs (less than 2.5-3 cm) with relatively preserved hearing function are preferably treated with function-preserving approach such as radiosurgery (RS) [4][5][6][7][8]. Large prospective studies with long-term follow-up data and matched-pair analysis have shown equivalent loco-regional control with RS and microsurgery [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, small ANs (less than 2.5-3 cm) with relatively preserved hearing function are preferably treated with function-preserving approach such as radiosurgery (RS) [4][5][6][7][8]. Large prospective studies with long-term follow-up data and matched-pair analysis have shown equivalent loco-regional control with RS and microsurgery [7][8][9][10][11]. The RS patient cohort had equivalent local control to the microsurgery arm, but patients with microsurgery had higher facial nerve paresis and hearing function impairment [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife®) stereotactic system plans for acoustic schwannoma

Dutta¹,

Subramanian²,

Murli³

et al. 2011

J Neurooncol

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A dosimetric comparison of linear accelerator (LA)-based (BrainLAB) and robotic radiosurgery (RS) (CyberKnife) systems for acoustic schwannoma (Acoustic neuroma, AN) was carried out. Seven patients with radiologically confirmed unilateral AN were planned with both an LA-based (BrainLAB) and robotic RS (CyberKnife) system using the same computed tomography (CT) dataset and contours. Gross tumour volume (GTV) was contoured on post-contrast magnetic resonance imaging (MRI) scan [planning target volume (PTV) margin 2 mm]. Planning and calculation were done with appropriate calculation algorithms. The prescribed isodose in both systems was considered adequate to cover at least 95% of the contoured target. Plan evaluations were done by examining the target coverage by the prescribed isodose line, and high- and low-dose volumes. Isodose plans and dose volume histograms generated by the two systems were compared. There was no statistically significant difference between the contoured volumes between the systems. Tumour volumes ranged from 380 to 3,100 mm(3). Dose prescription was 13-15 Gy in single fraction (median prescribed isodose 85%). There were no significant differences in conformity index (CI) (0.53 versus 0.58; P = 0.225), maximum brainstem dose (4.9 versus 4.7 Gy; P = 0.935), 2.5-Gy volume (39.9 versus 52.3 cc; P = 0.238) or 5-Gy volume (11.8 versus 16.8 cc; P = 0.129) between BrainLAB and CyberKnife system plans. There were statistically significant differences in organs at risk (OAR) doses, such as mean cochlear dose (6.9 versus 5.4 Gy; P = 0.001), mean mesial temporal dose (2.6 versus 1.7 Gy; P = 0.07) and high-dose (10 Gy) volume (3.2 versus 5.2 cc; P = 0.017). AN patients planned with the CyberKnife system had superior OAR (cochlea and mesial temporal lobe) sparing compared with those planned with the Linac-based system. Further evaluation of these findings in prospective studies with clinical correlation will provide actual clinical benefit from the dosimetric superiority of CyberKnife.

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“…The overall failure rate is about 15%, which is approximately in the same as for decompression. Chen et al identified preoperative factors which can determine the outcome for pain control: The response to anticonvulsant medication has been regarded as the single most important prognostic indicator for treatment success [3,23,53,54][59]B[62,67,70,78,82,86,90,97,102,106,116,118,122,124,126,151]. …”

Section: Other Indicationsmentioning

confidence: 99%

Current concepts in stereotactic radiosurgery - a neurosurgical and radiooncological point of view

et al. 2009

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Stereotactic radiosurgery is related to the history of "radiotherapy" and "stereotactic neurosurgery". The concepts for neurosurgeons and radiooncologists have been changed during the last decade and have also transformed neurosurgery. The gamma knife and the stereotactically modified linear accelerator (LINAC) are radiosurgical equipments to treat predetermined intracranial targets through the intact skull without damaging the surrounding normal brain tissue. These technical developments allow a more precise intracranial lesion control and offer even more conformal dose plans for irregularly shaped lesions. Histological determination by stereotactic biopsy remains the basis for any otherwise undefined intracranial lesion. As a minimal approach, it allows functional preservation, low risk and high sensitivity. Long-term results have been published for various indications. The impact of radiosurgery is presented for the management of gliomas, metastases, brain stem lesions, benign tumours and vascular malformations and selected functional disorders such as trigeminal neuralgia. In AVM's it can be performed as part of a multimodality strategy including resection or endovascular embolisation. Finally, the technological advances in radiation oncology as well as stereotactic neurosurgery have led to significant improvements in radiosurgical treatment opportunities. Novel indications are currently under investigation. The combination of both, the neurosurgical and the radiooncological expertise, will help to minimize the risk for the patient while achieving a greater treatment success.

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Stereotactic Radiation Techniques in the Treatment of Acoustic Schwannomas

Cited by 13 publications

References 28 publications

Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife®) stereotactic system plans for acoustic schwannoma

Current concepts in stereotactic radiosurgery - a neurosurgical and radiooncological point of view

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