Skip to main content
SpringerLink
Log in

Outcomes of stereotactic radiosurgery in young adults with vestibular schwannomas

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Vestibular schwannomas (VSs) are comparatively rare in younger patients, and stereotactic radiosurgery (SRS) outcome data are limited. We aimed to evaluate long-term SRS outcomes concerning sporadic VSs in patients aged ≤ 40 years.

Methods

Of 383 patients with VS who had undergone SRS at our institution between 1990 and 2017, we retrospectively compared younger and older patients’ tumor control and radiation-induced complication rates using case–control propensity score (PS) matching.

Results

The mean follow-up was 83 and 92 months in older and younger patients, respectively. Compared with older patients, younger patients were more likely to have a history of resection (20% vs. 39%, p = 0.006) and be treated with higher marginal doses (median, 12 Gy vs. 14 Gy; p = 0.014). Cumulative 5- and 10-year tumor control rates were higher in older patients (97.7% and 93.9%, respectively) than in younger patients (90.2% and 85.4%, respectively, p = 0.024). After PS matching, younger patients’ cumulative tumor control rates (93.6%, 85.4%, and 85.4% at 5, 10, and 15 years, respectively) were similar to those of older patients (p = 0.411). No significant between-cohort differences in hearing preservation rates or other cranial nerve complications were observed. Two younger patients had malignant tumors several years post-SRS, with one patient having confirmed histological transformation.

Conclusions

SRS is equally effective for younger and older patients. Complications other than hearing deterioration are uncommon. However, malignant transformation is possible, and long-term post-SRS surveillance MRI is important. These data are useful for decision-making involving young adults with VSs.

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

Similar content being viewed by others

Data availability

The data supporting the findings of this study are included in the article and its supplementary material file.

References

  1. 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

    Article  Google Scholar 

  2. Pollock BE, Driscoll CL, 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. https://doi.org/10.1227/01.NEU.0000219217.14930.14

    Article  PubMed  Google Scholar 

  3. Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, del Vecchio A, Bolognesi A, Picozzi P, Mortini P (2014) Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 121(Suppl):123–142. https://doi.org/10.3171/2014.8.GKS141506

    Article  PubMed  Google Scholar 

  4. Klijn S, Verheul JB, Beute GN, Leenstra S, Mulder JJ, Kunst HP, Hanssens PE (2016) Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands. J Neurosurg 124:1619–1626. https://doi.org/10.3171/2015.4.JNS142415

    Article  PubMed  Google Scholar 

  5. Hasegawa T, Kato T, Naito T, Tanei T, Ishii K, Tsukamoto E, Okada K (2020) Long-term outcomes of sporadic vestibular schwannomas treated with recent stereotactic radiosurgery techniques. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2020.05.029

    Article  PubMed  Google Scholar 

  6. Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C (2013) Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 119:121–130. https://doi.org/10.3171/2013.1.JNS121370

    Article  PubMed  Google Scholar 

  7. Allcutt DA, Hoffman HJ, Isla A, Becker LE, Humphreys RP (1991) Acoustic schwannomas in children. Neurosurgery 29:14–18. https://doi.org/10.1097/00006123-199107000-00003

    Article  CAS  PubMed  Google Scholar 

  8. Harada K, Nishizaki T, Adachi N, Suzuki M, Ito H (2000) Pediatric acoustic schwannoma showing rapid regrowth with high proliferative activity. Childs Nerv Syst 16:134–137. https://doi.org/10.1007/s003810050479

    Article  CAS  PubMed  Google Scholar 

  9. Pothula VB, Lesser T, Mallucci C, May P, Foy P (2001) Vestibular schwannomas in children. Otol Neurotol 22:903–907. https://doi.org/10.1097/00129492-200111000-00032

    Article  CAS  PubMed  Google Scholar 

  10. Rinaldi V, Casale M, Bressi F, Potena M, Vesperini E, De Franco A, Silvestri S, Zini C, Salvinelli F (2012) Facial nerve outcome after vestibular schwannoma surgery: our experience. J Neurol Surg B Skull Base 73:21–27. https://doi.org/10.1055/s-0032-1304559

    Article  PubMed  PubMed Central  Google Scholar 

  11. Falcioni M, Fois P, Taibah A, Sanna M (2011) Facial nerve function after vestibular schwannoma surgery. J Neurosurg 115:820–826. https://doi.org/10.3171/2011.5.JNS101597

    Article  PubMed  Google Scholar 

  12. Ansari SF, Terry C, Cohen-Gadol AA (2012) Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 33:E14. https://doi.org/10.3171/2012.6.FOCUS12163

    Article  PubMed  Google Scholar 

  13. Bloch O, Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Kaur G, Yang I, Pitts LH, Parsa AT (2011) Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma. J Neurooncol 102:281–286. https://doi.org/10.1007/s11060-010-0315-5

    Article  PubMed  Google Scholar 

  14. Johnson S, Kano H, Faramand A, Pease M, Nakamura A, Hassib M, Spencer D, Sisterson N, Faraji AH, Arai Y, Monaco E, Niranjan A, Flickinger JC, Lunsford LD (2019) Long term results of primary radiosurgery for vestibular schwannomas. J Neurooncol 145:247–255. https://doi.org/10.1007/s11060-019-03290-0

    Article  CAS  PubMed  Google Scholar 

  15. Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD (2001) Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experience using current methods. J Neurosurg 94:1–6. https://doi.org/10.3171/jns.2001.94.1.0001

    Article  CAS  PubMed  Google Scholar 

  16. Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D (1999) Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753–762. https://doi.org/10.1097/00006123-199910000-00003

    Article  CAS  PubMed  Google Scholar 

  17. Mindermann T, Schlegel I (2014) How to distinguish tumor growth from transient expansion of vestibular schwannomas following Gamma Knife radiosurgery. Acta Neurochir (Wien) 156:1121–1123. https://doi.org/10.1007/s00701-014-2063-3

    Article  Google Scholar 

  18. Frisch CD, Jacob JT, Carlson ML, Foote RL, Driscoll CL, Neff BA, Pollock BE, Link MJ (2017) Stereotactic radiosurgery for cystic vestibular schwannomas. Neurosurgery 80:112–118. https://doi.org/10.1227/NEU.0000000000001376

    Article  PubMed  Google Scholar 

  19. Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557–565. https://doi.org/10.3171/2012.10.JNS12523

    Article  PubMed  Google Scholar 

  20. Umekawa M, Hasegawa H, Shin M, Kawashima M, Nomura S, Nakatomi H, Saito N (2018) Radiosurgery-induced anterior inferior cerebellar artery pseudoaneurysm treated with trapping and bypass. World Neurosurg 116:209–213. https://doi.org/10.1016/j.wneu.2018.04.161

    Article  PubMed  Google Scholar 

  21. Shin M, Ueki K, Kurita H, Kirino T (2002) Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet 360:309–310. https://doi.org/10.1016/S0140-6736(02)09521-1

    Article  PubMed  Google Scholar 

  22. Kawashima M, Hasegawa H, Shin M, Takahashi W, Shinya Y, Iwasaki S, Kashio A, Nakatomi H, Saito N (2020) Long-term outcomes of gamma knife radiosurgery for treating vestibular schwannoma with a lower prescription dose of 12 Gy compared with higher dose treatment. Otol Neurotol 41:e1314–e1320. https://doi.org/10.1097/MAO.0000000000002885

    Article  PubMed  Google Scholar 

  23. Sughrue ME, Kaur R, Rutkowski MJ, Kane AJ, Yang I, Pitts LH, Parsa AT (2010) A critical evaluation of vestibular schwannoma surgery for patients younger than 40 years of age. Neurosurgery 67:1646–1653. https://doi.org/10.1227/NEU.0b013e3181f8d3d3

    Article  PubMed  Google Scholar 

  24. Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD (2009) Gamma knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery 65:294–300. https://doi.org/10.1227/01.NEU.0000345944.14065.35

    Article  PubMed  Google Scholar 

  25. Breshears JD, Chang J, Molinaro AM, Sneed PK, McDermott MW, Tward A, Theodosopoulos PV (2019) Temporal dynamics of pseudoprogression after gamma knife radiosurgery for vestibular schwannomas-a retrospective volumetric study. Neurosurgery 84:123–131. https://doi.org/10.1093/neuros/nyy019

    Article  PubMed  Google Scholar 

  26. Li LF, Yu CP, Tsang AC, Taw BB, Lui WM (2020) Near-complete regression 19 years after Gamma Knife radiosurgery of vestibular schwannoma with massive pseudoprogression: case report. J Neurosurg. https://doi.org/10.3171/2020.3.JNS20389

    Article  PubMed  Google Scholar 

  27. Kim JH, Jung HH, Chang JH, Chang JW, Park YG, Chang WS (2017) Predictive factors of unfavorable events after Gamma Knife radiosurgery for vestibular schwannoma. World Neurosurg 107:175–184. https://doi.org/10.1016/j.wneu.2017.07.139

    Article  PubMed  Google Scholar 

  28. Prabhuraj AR, Yeole U, Arimappamagan A, Rao KVLN, Bhat DI, Dwarakanath S, Govindswamy B, Somanna S (2019) Effect of Gamma Knife radiosurgery on vestibular schwannoma with serviceable hearing: a single-center Indian study. World Neurosurg 127:e114–e123. https://doi.org/10.1016/j.wneu.2019.02.169

    Article  Google Scholar 

  29. Yang I, Sughrue ME, Han SJ, Aranda D, Pitts LH, Cheung SW, Parsa AT (2010) A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. J Neurosurg 112:851–859. https://doi.org/10.3171/2009.8.JNS0985

    Article  PubMed  Google Scholar 

  30. Gouveris HT, Victor A, Mann WJ (2007) Cochlear origin of early hearing loss in vestibular schwannoma. Laryngoscope 117:680–683. https://doi.org/10.1097/MLG.0b013e31803146c5

    Article  PubMed  Google Scholar 

  31. Roosli C, Linthicum FH, Cureoglu S, Merchant SN (2012) Dysfunction of the cochlea contributing to hearing loss in acoustic neuromas: an underappreciated entity. Otol Neurotol 33:473–480. https://doi.org/10.1097/MAO.0b013e318248ee02

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Régis J (2009) Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 64:289–296. https://doi.org/10.1227/01.NEU.0000338256.87936.7C

    Article  PubMed  Google Scholar 

  33. Johnson S, Kano H, Faramand A, Niranjan A, Flickinger JC, Lunsford LD (2019) Predicting hearing outcomes before primary radiosurgery for vestibular schwannomas. J Neurosurg. https://doi.org/10.3171/2019.5.JNS182765

    Article  PubMed  Google Scholar 

  34. Park KY, Ahn JY, Lee JW, Chang JH, Huh SK (2009) De novo intracranial aneurysm formation after Gamma Knife radiosurgery for vestibular schwannoma. J Neurosurg 110:540–542. https://doi.org/10.3171/2008.9.JNS08860

    Article  PubMed  Google Scholar 

  35. Akamatsu Y, Sugawara T, Mikawa S, Saito A, Ono S, Takayama K, Jokura H, Seki H (2009) Ruptured pseudoaneurysm following Gamma Knife surgery for a vestibular schwannoma. J Neurosurg 110:543–546. https://doi.org/10.3171/2008.8.JNS08177

    Article  PubMed  Google Scholar 

  36. Matsumura H, Kato N, Hosoo H, Fujiwara Y (2015) Subarachnoid hemorrhage due to anterior inferior cerebellar artery aneurysms associated with Gamma Knife surgery for vestibular schwannomas. Acta Neurochir (Wien) 157:1765–1767. https://doi.org/10.1007/s00701-015-2552-z

    Article  Google Scholar 

  37. Takao T, Fukuda M, Kawaguchi T, Nishino K, Ito Y, Tanaka R, Sato M (2006) Ruptured intracranial aneurysm following gamma knife surgery for acoustic neuroma. Acta Neurochir (Wien) 148:1317–1318. https://doi.org/10.1007/s00701-006-0912-4

    Article  CAS  Google Scholar 

  38. Sunderland G, Hassan F, Bhatnagar P, Mitchell P, Jayakrishnan V, Forster D, Mendelow AD (2014) Development of anterior inferior cerebellar artery pseudoaneurysm after gamma knife surgery for vestibular schwannoma. A case report and review of the literature. Br J Neurosurg 28:536–538. https://doi.org/10.3109/02688697.2013.847168

    Article  PubMed  Google Scholar 

  39. Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT (2015) Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. BMJ Case Rep. https://doi.org/10.1136/bcr-2015-011736

    Article  PubMed  PubMed Central  Google Scholar 

  40. Murakami M, Kawarabuki K, Inoue Y, Ohta T (2016) Ruptured pseudoaneurysm after Gamma Knife surgery for vestibular schwannoma. Neurol Med Chir (Tokyo) 56:38–42. https://doi.org/10.2176/nmc.cr.2015-0034

    Article  Google Scholar 

  41. Cahan W, Woodard H (1948) Sarcoma arising in irradiated bone; report of 11 cases. Cancer 1:3–29

    Article  CAS  Google Scholar 

  42. Akamatsu Y, Murakami K, Watanabe M, Jokura H, Tominaga T (2010) Malignant peripheral nerve sheath tumor arising from benign vestibular schwannoma treated by gamma knife radiosurgery after two previous surgeries: a case report with surgical and pathological observations. World Neurosurg 73:751–754. https://doi.org/10.1016/j.wneu.2010.04.009

    Article  PubMed  Google Scholar 

  43. Yang T, Rockhill J, Born DE, Sekhar LN (2010) A case of high-grade undifferentiated sarcoma after surgical resection and stereotactic radiosurgery of a vestibular schwannoma. Skull Base 20:179–183. https://doi.org/10.1055/s-0029-1242195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Demetriades AK, Saunders N, Rose P, Fisher C, Rowe J, Tranter R, Hardwidge C (2010) Malignant transformation of acoustic neuroma/vestibular schwannoma 10 years after gamma knife stereotactic radiosurgery. Skull Base 20:381–387. https://doi.org/10.1055/s-0030-1253576

    Article  PubMed  PubMed Central  Google Scholar 

  45. Peker HO, Gok H, Altay T (2019) Malignant transformation of vestibular schwannoma after stereotactic radiosurgery. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.12.149

    Article  PubMed  Google Scholar 

  46. Yanamadala V, Williamson RW, Fusco DJ, Eschbacher J, Weisskopf P, Porter RW (2013) Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. World Neurosurg 79:593.e591-598. https://doi.org/10.1016/j.wneu.2012.03.016

    Article  Google Scholar 

  47. Wilkinson JS, Reid H, Armstrong GR (2004) Malignant transformation of a recurrent vestibular schwannoma. J Clin Pathol 57:109–110. https://doi.org/10.1136/jcp.57.1.109

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Thomsen J, Mirz F, Wetke R, Astrup J, Bojsen-Møller M, Nielsen E (2000) Intracranial sarcoma in a patient with neurofibromatosis type 2 treated with gamma knife radiosurgery for vestibular schwannoma. Am J Otol 21:364–370. https://doi.org/10.1016/s0196-0709(00)80046-0

    Article  CAS  PubMed  Google Scholar 

  49. Seferis C, Torrens M, Paraskevopoulou C, Psichidis G (2014) Malignant transformation in vestibular schwannoma: report of a single case, literature search, and debate. J Neurosurg 121(Suppl):160–166. https://doi.org/10.3171/2014.7.GKS141311

    Article  PubMed  Google Scholar 

  50. Chen H, Zhang X, Zhang Z, Yang T, Wang Z, Wu H (2014) The role of NF2 gene mutations and pathogenesis-related proteins in sporadic vestibular schwannomas in young individuals. Mol Cell Biochem 392:145–152. https://doi.org/10.1007/s11010-014-2011-9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Mariko Kawashima, Hirotaka Hasegawa, Masahiro Shin, Yuki Shinya & Nobuhito Saito

  2. Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan

    Atsuto Katano

Authors
  1. Mariko Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirotaka Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masahiro Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuki Shinya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsuto Katano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nobuhito Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and HH conceived and designed the study. MK conducted the literature search. MK, HH, YS, AK, MS and NS were involved in the analysis and interpretation of data. MK and HH drafted the manuscript. The study was supervised by MS and NS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mariko Kawashima.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (xlsx 63 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawashima, M., Hasegawa, H., Shin, M. et al. Outcomes of stereotactic radiosurgery in young adults with vestibular schwannomas. J Neurooncol 154, 93–100 (2021). https://doi.org/10.1007/s11060-021-03803-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-021-03803-w

Keywords

Search

Navigation