G Spatola1, R Carron2, C Delsanti2, J-M Thomassin3, P-H Roche4, J Régis2. 1. Inserm U751, Department of Functional and Stereotactic Neurosurgery Unit, centre hospitalier universitaire La Timone Assistance publique-Hôpitaux de Marseille, Aix Marseille University, 13385 Marseille, France; Department of Neurosurgery and Stereotactic Radiosurgery, Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132 Milan, Italy. Electronic address: giorgio.spatola@gmail.com. 2. Inserm U751, Department of Functional and Stereotactic Neurosurgery Unit, centre hospitalier universitaire La Timone Assistance publique-Hôpitaux de Marseille, Aix Marseille University, 13385 Marseille, France. 3. Department of ENT, centre hospitalier universitaire La Timone Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, 13385 Marseille, France. 4. Department of Neurosurgery, centre hospitalier universitaire hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, 13915 Marseille, France.
Abstract
INTRODUCTION: The aim of this study was to analyze the long-term results of Gamma-knife radiosurgery treatment of vestibular schwannomas in type 2 neurofibromatosis patients. MATERIALS AND METHODS: A cohort of 129 treatments for vestibular schwannomas in 103 patients was selected from a prospectively-maintained clinical database. Tumor control was assessed by volumetric analysis of the tumor at the last follow-up. Any need of a further procedure such as microsurgical removal or second treatment was regarded as a failure of tumor control. Hearing function was assessed based on Gardner-Robertson classification. Progression-free survival and functional hearing preservation rates were estimated using the Kaplan-Meier method. RESULTS: The median age at treatment was 34 years with no gender predominance. The median tumor volume was 1.5cm3. At a median clinical follow-up of 5.9 years, five patients had died, four underwent a second radiosurgical procedure and eight underwent microsurgical resection. Progression-free survival was 88 and 75% respectively at 5 and 10 years. Hearing was considered serviceable in 70 ears and remained functional in 28 ears. Kaplan-Meier estimates for 5 and 10 years functional hearing was 47 and 34%, respectively. Three patients developed new facial nerve palsy after radiosurgery at 15 days, 6 and 19 months respectively and only one partially recovered. Five patients complained of a subjective instability worsening. Four cases developed trigeminal neuropathy. No predictive factors were found to be statistically correlated with a better hearing outcome or an improved tumor growth control. CONCLUSION: Results prove less satisfying than in sporadic unilateral schwannomas. However, the lower rate of mortality and morbidity compared with microsurgical resection may support a proactive role of Gamma-knife in this pathology.
INTRODUCTION: The aim of this study was to analyze the long-term results of Gamma-knife radiosurgery treatment of vestibular schwannomas in type 2 neurofibromatosispatients. MATERIALS AND METHODS: A cohort of 129 treatments for vestibular schwannomas in 103 patients was selected from a prospectively-maintained clinical database. Tumor control was assessed by volumetric analysis of the tumor at the last follow-up. Any need of a further procedure such as microsurgical removal or second treatment was regarded as a failure of tumor control. Hearing function was assessed based on Gardner-Robertson classification. Progression-free survival and functional hearing preservation rates were estimated using the Kaplan-Meier method. RESULTS: The median age at treatment was 34 years with no gender predominance. The median tumor volume was 1.5cm3. At a median clinical follow-up of 5.9 years, five patients had died, four underwent a second radiosurgical procedure and eight underwent microsurgical resection. Progression-free survival was 88 and 75% respectively at 5 and 10 years. Hearing was considered serviceable in 70 ears and remained functional in 28 ears. Kaplan-Meier estimates for 5 and 10 years functional hearing was 47 and 34%, respectively. Three patients developed new facial nerve palsy after radiosurgery at 15 days, 6 and 19 months respectively and only one partially recovered. Five patients complained of a subjective instability worsening. Four cases developed trigeminal neuropathy. No predictive factors were found to be statistically correlated with a better hearing outcome or an improved tumor growth control. CONCLUSION: Results prove less satisfying than in sporadic unilateral schwannomas. However, the lower rate of mortality and morbidity compared with microsurgical resection may support a proactive role of Gamma-knife in this pathology.
Authors: Umberto Tosi; Omri Maayan; Anjile An; Miguel E Tusa Lavieri; Sergio W Guadix; Antonio P DeRosa; Paul J Christos; Susan Pannullo; Philip E Stieg; Andrew Brandmaier; Jonathan P S Knisely; Rohan Ramakrishna Journal: J Neurooncol Date: 2022-01-18 Impact factor: 4.130
Authors: Junhyung Kim; Yukyeng Byeon; Sang Woo Song; Young Hyun Cho; Chang-Ki Hong; Seok Ho Hong; Jeong Hoon Kim; Do Heui Lee; Ji Eun Park; Ho Sung Kim; Young-Hoon Kim Journal: Front Oncol Date: 2022-09-16 Impact factor: 5.738