Skip to main content
SpringerLink
Log in

Repeated treatment of vestibular schwannomas after gamma knife radiosurgery

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

When gamma knife radiosurgery (GKS) does not achieve control of the growth of a tumour, the need to repeat treatment is considered. The results and risks of repeat treatment of patients with a vestibular schwannoma were reviewed to assess its efficacy and safety.

Methods

Between 1992 and 2001, we treated 351 patients with a vestibular schwannoma by GKS, control of the growth of the tumour was not achieved in 32. 26 patients underwntrepeat GKS and five patients had an open microsurgical operation and one stereotactic aspiration of a tumour cyst.

Results

Twenty-four of 26 patients were followed up after the repeat GKS for a median of 43 months. 15 tumours became smaller, seven remained unchanged and two enlarged. After the second GKS one patient’s hearing deteriorated, one developed facial weakness and three facial spasms. One patient required insertion of ventriculo-peritoneal drainage. An operation to radically resect the tumour was performed in five patients after the first GKS and for a subtotal removal in one after repeated GKS.

Conclusions

In the small proportion of patients (9%) in whom initial GKS does not control the growth of a vestibular schwannoma, most can be controlled by further GKS with a very low risk of a complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bertalanffy A, Dietrich W, Aichholzer M, Brix R, Ertl A, Heimberger K, Kitz K (2001) Gamma knife radiosurgery of acoustic neurinomas. Acta Neurochir (Wien) 143(7):689–695. doi:10.1007/s007010170047

    Article  CAS  Google Scholar 

  2. Betka J, Zverina E, Chovanec M, Skrivan J, Kluh J, Kraus J (2007) Differences in microsurgical treatment of small (grade 1,2) and large (grade 3,4) vestibular schwannomas. Skull Base 17(suppl 1):85. (Abstract)

    Google Scholar 

  3. Delsanti C, Roche PH, Thomassin JM, Régis J (2008) Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure. Prog Neurol Surg 21:93–97. doi:10.1159/000156712

    Article  PubMed  Google Scholar 

  4. Hasegawa T, Kida Y, Yoshimoto M, Koike J, Goto K (2006) Evaluation of tumour expansion after stereotactic radiosurgery in patients harboring vestibular schwannomas. Neurosurgery 58:1119–1128. doi:10.1227/01.NEU.0000215947.35646.DD

    Article  PubMed  Google Scholar 

  5. Iwai Y, Yamanaka K, Shiotani M, Uyama T (2003) Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53(2):282–288. doi:10.1227/01.NEU.0000073416.22608.B3

    Article  PubMed  Google Scholar 

  6. Iwai Y, Yamanaka K, Yamagata K, Yasui T (2007) Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings. Neurosurgery 60(ONS Suppl 1):ONS–75–ONS-82

    Google Scholar 

  7. Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger J (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433. doi:10.1056/NEJM199811123392003

    Article  PubMed  CAS  Google Scholar 

  8. Kwon Y, Kim JH, Lee DJ, Kim CJ, Lee JK, Kwun BD (1998) Gamma knife treatment of acoustic neurinoma. Stereotact Funct Neurosurg 70(Suppl 1):57–64. doi:10.1159/000056407

    Article  PubMed  Google Scholar 

  9. Landy HJ, Markoe AM, Wu X, Patchen SJ, Reis IM, Takita C, Abdel-Wahab MM, Wen BC, Wolfson AH, Huang DT (2004) Safety and efficacy of tiered limited-dose gamma knife stereotactic radiosurgery for unilateral acoustic neuroma. Stereotact Funct Neurosurg 82(4):147–152. doi:10.1159/000081347

    Article  PubMed  Google Scholar 

  10. Liščák R, Vladyka V, Urgošík D, Šimonová G, Novotný J Jr, Bareš K (1998) Acoustic neurinoma and its treatment using Leksell gamma knife. Otorinolaryngol Prague 47(3):103–115

    Google Scholar 

  11. Litvack ZN, Noren G, Chougule PB, Zheng Z (2003) Preservation of functional hearing after gamma knife surgery for vestibular schwannoma. Neurosurg Focus 14(5):e3. doi:10.3171/foc.2003.14.5.4

    Article  PubMed  Google Scholar 

  12. Leksell L (1971) A note on the treatment of acoustic tumours. Acta Chir Scand 136:763–765

    Google Scholar 

  13. Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D (2005) Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102(Suppl):195–199

    PubMed  Google Scholar 

  14. Nagano O, Higuchi Y, Serizawa T, Ono J, Matsuda S, Yamakami I, Saeki N (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109:811–816. doi:10.3171/JNS/2008/109/11/0811

    Article  PubMed  Google Scholar 

  15. Norén G (1998) Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70(Suppl 1):65–73. doi:10.1159/000056408

    PubMed  Google Scholar 

  16. Norén G (1998) Gamma knife radiosurgery for acoustic neurinomas. In: Gildenberg PL, Tasker RR (eds) Textbook of stereotactic and functional neurosurgery. New York, McGraw-Hill, pp 835–844

    Google Scholar 

  17. Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS (2001) Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49(6):1299–1306. doi:10.1097/00006123-200112000-00003

    Article  PubMed  CAS  Google Scholar 

  18. Pollock BE, Driscoll CLW, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management. A prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85. doi:10.1227/01.NEU.0000219217.14930.14

    Article  PubMed  Google Scholar 

  19. Pollock B (2006) Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 years experience. Neurosurgery 58:241–248. doi:10.1227/01.NEU.0000194833.66593.8B

    Article  PubMed  Google Scholar 

  20. Prasad D, Steiner M, Steiner L (2000) Gamma surgery for vestibular schwannoma. J Neurosurg 92(5):745–759

    PubMed  CAS  Google Scholar 

  21. Regis J, Delsanti C, Roche PH, Thomassin JM, Pellet W (2004) Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature. Neurochirurgie 50:301–311

    PubMed  CAS  Google Scholar 

  22. Régis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanaret M, Peragut JC (2002) Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100

    Article  PubMed  Google Scholar 

  23. Rowe JG, Radatz MW, Walton L, Hampshire A, Seaman S, Kemeny AA (2003) Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas. J Neurol Neurosurg Psychiatry 74(11):1536–1542. doi:10.1136/jnnp.74.11.1536

    Article  PubMed  CAS  Google Scholar 

  24. Unger F, Walch C, Schrottner O, Eustacchio S, Sutter B, Pendl G (2002) Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir (Wien) 84(Suppl):77–83

    CAS  Google Scholar 

  25. Wowra B, Muacevic A, Jess-Hempen A, Hempel J, Muller-Schunk S, Tonn J (2005) Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience. J Neurosurg 102(Suppl):114–118

    PubMed  Google Scholar 

  26. Yu CP, Cheung JYC, Leung S, Ho R (2000) Sequential volume mapping for confirmation of negative growth in vestibular schwannomas treated by gamma knife radiosurgery. J Neurosurg 93(Suppl 3):82–89

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stereotactic and radiation neurosurgery, Na Homolce Hospital, Roentgenova 2, Prague, 150 30, Czech Republic

    Roman Liscak, Vilibald Vladyka, Dusan Urgosik & Gabriela Simonova

  2. Department of radiology, Na Homolce Hospital, Roentgenova 2, Prague, 150 30, Czech Republic

    Josef Vymazal

Authors
  1. Roman Liscak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vilibald Vladyka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dusan Urgosik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriela Simonova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Josef Vymazal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roman Liscak.

Additional information

Comment

These experienced authors report their results after repeat radiosurgery for acoustic neuromas. After initial management, 9% of tumors underwent an additional radiosurgery or resection. This percentage is higher than in most other series and may reflect their unwillingness to follow tumors that have only transiently expanded but are not really growing. Most groups report a 2–3% rate for additional surgery. It may also reflect an initial willingness to use radiosurgery for larger tumors. After a second radiosurgery, they still had an 8% failure rate. As they note, a second gamma knife radiosurgery can be safe and effective for the majority of patients who have some tumor enlargement following initial care.

Douglas Kondziolka

Pittsburgh, Pennsylvania

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liscak, R., Vladyka, V., Urgosik, D. et al. Repeated treatment of vestibular schwannomas after gamma knife radiosurgery. Acta Neurochir 151, 317–324 (2009). https://doi.org/10.1007/s00701-009-0254-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-009-0254-0

Keywords

Search

Navigation