Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

被引:64
作者
Frischer, Josa M. [1 ]
Gruber, Elise [1 ]
Schoeffmann, Verena [1 ]
Ertl, Adolf [1 ]
Hoeftberger, Romana [4 ]
Mallouhi, Ammar [2 ]
Wolfsberger, Stefan [1 ]
Arnoldner, Christoph [3 ]
Eisner, Wilhelm [5 ]
Knosp, Engelbert [1 ]
Kitz, Klaus [1 ]
Gatterbauer, Brigitte [1 ]
机构
[1] Med Univ Vienna, Dept Neurosurg, Vienna, Austria
[2] Med Univ Vienna, Dept Radiol, Vienna, Austria
[3] Med Univ Vienna, Dept Otorhinolaryngol, Vienna, Austria
[4] Med Univ Vienna, Inst Neurol, Vienna, Austria
[5] Med Univ Innsbruck, Dept Neurosurg, Innsbruck, Austria
关键词
Gamma Knife radiosurgery; acoustic neuroma; vestibular schwannoma; Koos grade; hydrocephalus; hearing preservation; stereotactic radiosurgery; VESTIBULAR SCHWANNOMA MANAGEMENT; STEREOTACTIC RADIOSURGERY; MALIGNANT-TRANSFORMATION; NEUROFIBROMATOSIS TYPE-2; HEARING PRESERVATION; FOLLOW-UP; SURGERY; MICROSURGERY; DISPARITIES; EXPERIENCE;
D O I
10.3171/2017.8.JNS171281
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma. METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up. RESULTS Four hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up. CONCLUSIONS In small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.
引用
收藏
页码:388 / 397
页数:10
相关论文
共 42 条
[1]   Early Radiosurgery Improves Hearing Preservation in Vestibular Schwannoma Patients With Normal Hearing at the Time of Diagnosis [J].
Akpinar, Berkcan ;
Mousavi, Seyed H. ;
McDowell, Michael M. ;
Niranjan, Ajay ;
Faraji, Amir H. ;
Flickinger, John C. ;
Lunsford, L. Dade .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2016, 95 (02) :729-734
[2]  
Arnoldner C., 2013, Cochlear Implants Int, V14, P10
[3]   A review of treatment modalities for vestibular schwannoma [J].
Arthurs, Benjamin J. ;
Fairbanks, Robert K. ;
Demakas, John J. ;
Lamoreaux, Wayne T. ;
Giddings, Neil A. ;
Mackay, Alexander R. ;
Cooke, Barton S. ;
Elaimy, Ameer L. ;
Lee, Christopher M. .
NEUROSURGICAL REVIEW, 2011, 34 (03) :265-277
[4]   Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management Clinical article [J].
Babu, Ranjith ;
Sharma, Richa ;
Bagley, Jacob H. ;
Hatef, Jeffrey ;
Friedman, Allan H. ;
Adamson, Cory .
JOURNAL OF NEUROSURGERY, 2013, 119 (01) :121-130
[5]   Recording of electrically evoked auditory brainstem responses (E-ABR) with an integrated stimulus generator in Matlab [J].
Bahmer, Andreas ;
Peter, Otto ;
Baumann, Uwe .
JOURNAL OF NEUROSCIENCE METHODS, 2008, 173 (02) :306-314
[6]   Gamma Knife Radiosurgery as Primary Treatment for Large Vestibular Schwannomas: Clinical Results at Long-Term Follow-Up in a Series of 59 Patients [J].
Bailo, Michele ;
Boari, Nicola ;
Franzin, Alberto ;
Gagliardi, Filippo ;
Spina, Alfio ;
del Vecchio, Antonella ;
Gemma, Marco ;
Bolognesi, Angelo ;
Mortini, Pietro .
WORLD NEUROSURGERY, 2016, 95 :487-501
[7]   Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients [J].
Boari, Nicola ;
Bailo, Michele ;
Gagliardi, Filippo ;
Franzin, Alberto ;
Gemma, Marco ;
del Vecchio, Antonella ;
Bolognesi, Angelo ;
Picozzi, Piero ;
Mortini, Pietro .
JOURNAL OF NEUROSURGERY, 2014, 121 :123-142
[8]   Malignant peripheral nerve sheath tumors of the eighth cranial nerve arising without prior irradiation [J].
Carlson, Matthew L. ;
Jacob, Jeffrey T. ;
Habermann, Elizabeth B. ;
Glasgow, Amy E. ;
Raghunathan, Aditya ;
Link, Michael J. .
JOURNAL OF NEUROSURGERY, 2016, 125 (05) :1120-1129
[9]   The Changing Landscape of Vestibular Schwannoma Management in the United StatesA Shift Toward Conservatism [J].
Carlson, Matthew L. ;
Habermann, Elizabeth B. ;
Wagie, Amy E. ;
Driscoll, Colin L. ;
Van Gompel, Jamie J. ;
Jacob, Jeffrey T. ;
Link, Michael J. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2015, 153 (03) :440-446
[10]   Management of Sporadic Vestibular Schwannoma [J].
Carlson, Matthew L. ;
Link, Michael J. ;
Wanna, George B. ;
Driscoll, Colin L. W. .
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA, 2015, 48 (03) :407-+