Long term results of primary radiosurgery for vestibular schwannomas

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

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)247-255
Number of pages9
JournalJournal of Neuro-Oncology
Volume145
Issue number2
DOIs
StatePublished - Nov 1 2019

Keywords

  • Acoustic neuroma: Gamma knife
  • Stereotactic radiosurgery
  • Vestibular schwannoma
  • hearing

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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