Abstract
Background: Gamma Knife surgery (GKS) should be considered a standard treatment option for small and medium-sized vestibular schwannomas (VSs). It results in a tumor control rate similar to that seen with microsurgery and provides better preservation of facial nerve function and hearing.
Methods: From December 2002 to April 2011, a total of 260 patients with VS underwent GKS using Leksell Gamma Knife model 4C with an automatic positioning system. There were 30 Koos stage I tumors, 112 stage II, 100 stage III, and 18 stage IV. All patients were treated with the use of high-resolution magnetic resonance imaging; creation of the highly precise conformal and selective multi-isocenter dose planning with small collimators, carefully sparing adjacent cranial nerves of any excessive irradiation; and creation of a wide 80 % isodose area within the tumor while applying a low marginal dose (mean 11.9 Gy) at the 50 % isodose line.
Results: Among 182 patients who were followed for more than 3 years after treatment, the tumor control and shrinkage rates were 98.4 % and 76.4 %, respectively. Volume reduction of >50 % was marked in 54.9 % of VSs. Preservation of facial nerve function and hearing at the pretreatment level was noted in 97.8 % and 87.9 %, respectively. There was marked improvement of facial nerve function and hearing after GKS in 2.2 % and 3.8 %, respectively. There was no major morbidity.
Conclusion: Due to contemporary technological and methodological achievements GKS can be focused not only on growth control but on shrinking the VS, with possible reversal of the neurological deficit.
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References
Chung WY, Liu KD, Shiau CY, Wu HM, Wang LW, Guo WY, Ho DM, Pan DH (2005) Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 102(Suppl):87–96
Combs SE, Thilmann C, Debus J, Schulz-Ertner D (2006) Long-term outcome of stereotactic radiosurgery (SRS) in patients with acoustic neuromas. Int J Radiat Oncol Biol Phys 64:1341–1347
Gabert K, Regis J, Delsanti C, Roche PH, Facon F, Tamura M, Pellet W, Thomassin JM (2004) Preserving hearing function after Gamma Knife radiosurgery for unilateral vestibular schwannoma. Neurochirurgie 50:350–357 (in French)
Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66
Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J (2005) Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 57:257–265
Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J (2005) Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up. J Neurosurg 102:10–16
Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Maruyama T, Yomo S, Izawa M, Hori T, Takakura K, Regis J (2006) Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 105(Suppl):5–11
Hayashi M, Tamura N, Maruyama T, Nakaya K, Ochiai T, Chernov M, Yomo S, Anami H, Izawa M, Ono Y, Okada Y, Hori T, Takakura K (2010) Current treatment strategy of Gamma Knife surgery for vestibular schwannoma: image-guided and robotized microradiosurgery. In: McDermott MW (ed) Radiosurgery, vol 7. Karger, Basel, pp 175–188
Held P, Fellner C, Seitz J, Graf S, Fellner F, Strutz J (1999) The value of T2(*)-weighted MR images for the diagnosis of acoustic neuromas. Eur J Radiol 30:237–244
House WF, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:184–193
Koos WT (1988) Criteria for preservation of vestibulocochlear nerve function during microsurgical removal of acoustic neurinomas. Acta Neurochir (Wien) 92:55–66
Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512
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
Maruyama T, Muragaki Y, Hori T (2006) Surgical technique for vestibular schwannoma. No Shinkei Geka 34:681–693 (in Japanese)
Massager N, Nissim O, Delbrouck C, Devriendt D, David P, Desmedt F, Wikler D, Hassid S, Brotchi J, Levivier M (2006) Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. Int J Radiat Oncol Biol Phys 64:1331–1340
Myrseth E, Moller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 56:927–935
Naganawa S, Koshikawa T, Fukatsu H, Ishigaki T, Fukuta T (2001) MR cisternography of the cerebellopontine angle: comparison of three-dimensional fast asymmetrical spin-echo and three-dimensional constructive interference in the steady-state sequences. AJNR Am J Neuroradiol 22:1179–1185
Nakamura H, Jokura H, Takahashi K, Boku N, Akabane A, Yoshimoto T (2000) Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR Am J Neuroradiol 21:1540–1546
Paek SH, Chung HT, Jeong SS, Park CK, Kim CY, Kim JE, Kim DG, Jung HW (2005) Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 104:580–590
Pollock BE (2006) Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 58:241–248
Regis J, Hayashi M, Porcheron D, Delsanti C, Muracciole X, Peragut JC (2002) Impact of the model C and Automatic Positioning System on gamma knife radiosurgery: an evaluation in vestibular schwannomas. J Neurosurg 97(5 Suppl):588–591
Regis J, David P, Wikler D, Porcheron D, Levrier O (2004) Stereotactic mapping for radiosurgical treatment of vestibular schwannomas. Neurochirurgie 50:270–281 (in French)
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 74:1536–1542
Shigematsu Y, Korogi Y, Hirai T, Okuda T, Ikushima I, Sugahara T, Liang L, Takahashi M (1999) Contrast-enhanced CISS MRI of vestibular schwannomas: phantom and clinical studies. J Comput Assist Tomogr 23:224–231
Tamura M, Murata N, Hayashi M, Regis J (2004) Injury of the lacrimal component of the nervus intermedius function after radiosurgery versus microsurgery. Neurochirurgie 50:338–344
Tlachacova D, Schmitt M, Novotny J Jr, Novotny J, Majali M, Liscak R (2005) A comparison of the gamma knife model C and the automatic positioning system with Leksell model B. J Neurosurg 102(Suppl):25–28
van Eck AT, Horstmann GA (2005) Increased preservation of functional hearing after gamma knife surgery for vestibular schwannoma. J Neurosurg 102(Suppl):204–206
Acknowledgment
Drs. Pavel Ivanov and Samuel M. Lipski had training fellowships in the Gamma Knife Unit of the Tokyo Women’s Medical University from May to September 2007 and from October to November 2009, respectively.
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The authors declare that they have no conflict of interest.
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Hayashi, M. et al. (2013). Do We Really Still Need an Open Surgery for Treatment of Patients with Vestibular Schwannomas?. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_5
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DOI: https://doi.org/10.1007/978-3-7091-1376-9_5
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