OBJECTIVE: We present the previously unreported outcomes of 70 patients treated with Gamma knife radiosurgery for vestibular schwannoma (VS), including comprehensive analysis of clinical outcomes and the effects of lower marginal doses. METHODS: We performed a retrospective study of patients treated for VS at Gamma knife of Spokane between 2003 and 2008. Endpoints measured include tumor control, hearing preservation, and facial nerve preservation, including the effect of tumor size and marginal dose. Statistical analysis was performed with Wilcoxon signed-rank test, paired Student t test, Mann-Whitney U test, Kendall's rank correlation, Fisher exact test, and Liddell's exact χ(2) test for matched pairs. RESULTS: With a mean follow-up of 26 months, 93.8% of tumors either shrank or remained static after receiving a mean marginal dose of 12.7 Gy. Tumor control was independent of marginal dose or tumor size. Hearing preservation was achieved in 64% of patients with serviceable function before the treatment. Hearing changes were independent of dose or tumor size. Preservation of good facial nerve function was achieved in 95% of patients. Post-treatment hydrocephalus occurred in 4.4% of patients, but no other significant morbidities were elucidated. CONCLUSIONS: In the treatment of VS, contemporary radiosurgical techniques and the use of marginal doses below 13 Gy offer excellent tumor control, at high rates relative to surgical intervention. These findings are independent of marginal dose and tumor size. Patients should be informed about the benefits and risks of radiosurgery and microsurgery before choosing an intervention. Further analysis of post-treatment outcomes should be encouraged as follow-up times increase and the treatment protocols continue to evolve.
OBJECTIVE: We present the previously unreported outcomes of 70 patients treated with Gamma knife radiosurgery for vestibular schwannoma (VS), including comprehensive analysis of clinical outcomes and the effects of lower marginal doses. METHODS: We performed a retrospective study of patients treated for VS at Gamma knife of Spokane between 2003 and 2008. Endpoints measured include tumor control, hearing preservation, and facial nerve preservation, including the effect of tumor size and marginal dose. Statistical analysis was performed with Wilcoxon signed-rank test, paired Student t test, Mann-Whitney U test, Kendall's rank correlation, Fisher exact test, and Liddell's exact χ(2) test for matched pairs. RESULTS: With a mean follow-up of 26 months, 93.8% of tumors either shrank or remained static after receiving a mean marginal dose of 12.7 Gy. Tumor control was independent of marginal dose or tumor size. Hearing preservation was achieved in 64% of patients with serviceable function before the treatment. Hearing changes were independent of dose or tumor size. Preservation of good facial nerve function was achieved in 95% of patients. Post-treatment hydrocephalus occurred in 4.4% of patients, but no other significant morbidities were elucidated. CONCLUSIONS: In the treatment of VS, contemporary radiosurgical techniques and the use of marginal doses below 13 Gy offer excellent tumor control, at high rates relative to surgical intervention. These findings are independent of marginal dose and tumor size. Patients should be informed about the benefits and risks of radiosurgery and microsurgery before choosing an intervention. Further analysis of post-treatment outcomes should be encouraged as follow-up times increase and the treatment protocols continue to evolve.
Authors: Kunal S Patel; Edwin Ng; Taranjit Kaur; Tyler Miao; Tania Kaprealian; Percy Lee; Nader Pouratian; Michael T Selch; Antonio A F De Salles; Quinton Gopen; Stephen Tenn; Isaac Yang Journal: J Neurooncol Date: 2019-09-24 Impact factor: 4.130
Authors: Hossein Mahboubi; Ronald Sahyouni; Omid Moshtaghi; Kent Tadokoro; Yaser Ghavami; Kasra Ziai; Harrison W Lin; Hamid R Djalilian Journal: Otolaryngol Head Neck Surg Date: 2017-04-25 Impact factor: 3.497
Authors: Andrew J Schumacher; Rohan R Lall; Rishi R Lall; Allan Nanney; Amit Ayer; Samir Sejpal; Benjamin P Liu; Maryanne Marymont; Plato Lee; Bernard R Bendok; John A Kalapurakal; James P Chandler Journal: J Neurol Surg B Skull Base Date: 2016-05-31
Authors: Lawrance K Chung; Nolan Ung; John P Sheppard; Thien Nguyen; Carlito Lagman; Winward Choy; Stephen Tenn; Nader Pouratian; Percy Lee; Tania Kaprealian; Michael Selch; Antonio De Salles; Quinton Gopen; Isaac Yang Journal: J Neurol Surg B Skull Base Date: 2017-11-10