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- Title
Gamma-knife surgery for unilateral koos iv vestibular schwannomas: long-term outcomes.
- Authors
Régis, J.; Da Roz, L.; Tancu, C.; Delsanti, C.; Thomassin, J. M.; Roche, P. H.
- Abstract
Object: In large Vestibular Schwannomas (VS), microsurgery is the main treatment option, associated or not with Gamma Knife Surgery (GKS) to achieve long-term growth control of residual VS after an incomplete resection. However, some patients do not present with symptomatic mass effect or may be old, suffer from severe comorbidities, or even refuse the surgical procedure. In these cases GKS may be a treatment option for large VS. In this study, we report the authors experience in GKS for large VS, evaluating the morbidity and tumor-rate control in our institution, only in these exceptional cases. Methods: Out of our cohort 3332 VS treated by radiosurgery in the Stereotactic and Functional Neurosurgery Department of Timone University Hospital we analyzed retrospectively 109 consecutive patients who underwent GKS for small Koos IV VS between July 1992 and November 2011. We excluded VS in NFII patients, 1 triton tumor, and those treated less than 3 years ago. No patient had symptomatic brainstem compression at the time of GKS. Radiosurgery was performed using a Gamma Knife (model B, C, 4C and perfexion) based on both CT and MR high resolution stereotactic images. Serial imaging with volume measurements, audiometry and clinical follow-up were performed for at least 3 years from the moment of the GKS. Results: Were included 95 VS patients with a median age of 54,5 years (23-84), with a median of the maximum dimension of 22,6mm (10-38) and a median marginal dose of 11 Gy (8-13). Three patients have been subsequently operated microsurgically due to a failure. The tumor control rate at the last follow up was 96,4% which is significantly lower than our overall tumor control rate in VS (98%). Shunting have been performed for treatment of symptomatic hydrocephalus in 4 patients. No facial palsy was observed at any time in this population. A functional hearing was preserved in 68,5% of the patients presenting with a functional hearing at the time of radiosurgery. Conclusions: Gamma Knife Surgery in Koos IV vestibular Schwannomas, without major brainstem compression, is turning out to as safe as in smaller tumors. These results are comparing very favorably to the very best results of resection for the same kind of tumors. Tumor control is turning out to be slightly lower but still very satisfactory in this difficult group of patients. Disclosure: No significant relationships.
- Subjects
ACOUSTIC neuroma; RADIOSURGERY; COMORBIDITY; STEREOTACTIC radiotherapy; STEREOTACTIC radiosurgery; TUMORS; THERAPEUTICS
- Publication
Journal of Radiosurgery & SBRT, 2013, Vol 2, p172
- ISSN
2156-4639
- Publication type
Article