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Journal of Neuro-Oncology

, Volume 145, Issue 2, pp 247–255 | Cite as

Long term results of primary radiosurgery for vestibular schwannomas

  • Stephen Johnson
  • Hideyuki KanoEmail author
  • Andrew Faramand
  • Matthew Pease
  • Aya Nakamura
  • Mohab Hassib
  • David Spencer
  • Nathaniel Sisterson
  • Amir H. Faraji
  • Yoshio Arai
  • Edward Monaco
  • Ajay Niranjan
  • John C. Flickinger
  • L. Dade Lunsford
Clinical Study

Abstract

Background

Stereotactic radiosurgery (SRS) has become a primary option for management for both newly diagnosed vestibular schwannomas (VS), as well as VS that enlarge after initial observation.

Methods

A retrospective review of our prospectively maintained data base found 871 patients who underwent Gamma knife® SRS as their initial (primary) management between 1987 and 2008. Follow-up ranged from 1–25 years (median = 5.2 years) Median tumor volume was 0.9 cc (0.02–36) and median margin dose was 13 Gy (12–25).

Results

Progression free survival (PFS) after SRS was 97% at 3 years, 95% at 5 years, and 94% at 10 years. Freedom from delayed surgical resection was found in 98.7% of patients. Smaller tumor volume was significantly associated with improved PFS. There were 326 patients with serviceable hearing (Gardner–Robertson 1 or 2) at the time of SRS with audiological follow-up of ≥ 1 year. Serviceable hearing preservation rates after SRS were 89.8% at 1 year, 76.9% at 3 years, 68.4% at 5 years, 62.5% at 7 years, and 51.4% at 10 years. Factors associated with improved serviceable hearing preservation included younger age, Gardner-Robertson grade 1 at SRS, and absence of subjective complaints of dysequilibrium or vertigo (vestibulopathy). Fifty-one patients (5.8%) developed trigeminal neuropathy. Fourteen (1.6%) developed a transient House-Brackmann grade 2 or 3 facial neuropathy.

Conclusions

In this report with extended follow-up, primary SRS achieved tumor growth control in 94% of patients. Optimization of long- term cranial nerve outcomes remains an important achievement of this management strategy for VS.

Keywords

Acoustic neuroma: Gamma knife Stereotactic radiosurgery Vestibular schwannoma hearing 

Notes

Acknowledgements

The work described in this report was funded by a research Grant to Dr. Kano from AB Elekta, Stockholm, Sweden.

Compliance with ethical standards

Conflict of interest

All authors other than HK declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Stephen Johnson
    • 1
    • 3
  • Hideyuki Kano
    • 1
    • 3
    • 4
    Email author
  • Andrew Faramand
    • 1
    • 3
  • Matthew Pease
    • 1
    • 3
  • Aya Nakamura
    • 1
    • 3
  • Mohab Hassib
    • 1
    • 3
  • David Spencer
    • 1
    • 3
  • Nathaniel Sisterson
    • 1
    • 3
  • Amir H. Faraji
    • 1
    • 3
  • Yoshio Arai
    • 2
    • 3
  • Edward Monaco
    • 1
    • 3
  • Ajay Niranjan
    • 1
    • 3
  • John C. Flickinger
    • 2
    • 3
  • L. Dade Lunsford
    • 1
    • 3
  1. 1.Departments of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Radiation OncologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.The Center for Image-Guided NeurosurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Neurological SurgeryUniversity of Pittsburgh, UPMC PresbyterianPittsburghUSA

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