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Long term results of primary radiosurgery for vestibular schwannomas

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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.

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Acknowledgements

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

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Author notes

  1. Stephen Johnson and Hideyuki Kano have contributed equally to this work.

Authors and Affiliations

  1. Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Stephen Johnson, Hideyuki Kano, Andrew Faramand, Matthew Pease, Aya Nakamura, Mohab Hassib, David Spencer, Nathaniel Sisterson, Amir H. Faraji, Edward Monaco, Ajay Niranjan & L. Dade Lunsford

  2. Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Yoshio Arai & John C. Flickinger

  3. The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Stephen Johnson, Hideyuki Kano, 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

  4. Neurological Surgery, University of Pittsburgh, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Hideyuki Kano

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  1. Stephen Johnson
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Correspondence to Hideyuki Kano.

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Johnson, S., Kano, H., Faramand, A. et al. Long term results of primary radiosurgery for vestibular schwannomas. J Neurooncol 145, 247–255 (2019). https://doi.org/10.1007/s11060-019-03290-0

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