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Gamma Knife Radiosurgery for Large Vestibular Schwannomas: A Canadian Experience

Published online by Cambridge University Press:  23 September 2014

F. A. Zeiler ,
M. Bigder ,
A. Kaufmann ,
P. J. McDonald ,
D. Fewer ,
J. Butler ,
G. Schroeder  and
M. West
F. A. Zeiler*
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
M. Bigder
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
A. Kaufmann
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
P. J. McDonald
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
D. Fewer
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
J. Butler
Affiliation:
Department of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
G. Schroeder
Affiliation:
Department of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
M. West
Affiliation:
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
*
Section of Neurosurgery, University of Manitoba, Health Sciences Center, GB-1 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. Email: umzeiler@cc.umanitoba.ca.
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Abstract

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Object:

To review our institutional experience with Gamma Knife (GK) stereotactic radiosurgery in treating large vestibular schwannomas (VS) of 3 to 4 cm diameter.

Methods:

We conducted a retrospective cohort review of all patients treated with GK for VS at our institution between November 2003 and March 2012. Data on age, sex, VS volume, location and maximal diameter, House-Brackmann (HB) facial nerve scores pre and post-GK, Gardner-Robertson (GR) hearing score pre and post-GK, GK treatment parameters, VS response time, complications and clinical outcome was recorded.

Results:

A total of 28 patients during the defined time period were identified. Three patients were lost to follow-up. Mean follow-up was 34.5 months. Tumor control occurred in 92%, and was maintained in 85.7% at two years. Facial nerve or hearing preservation occurred in all treated compared to pre-GK status, as per HB and GR grading. Transient complications occurred in 80%. Temporary vestibular dysfunction occurred in seven patients (28%). One patient (4%) had the permanent complication of worsening pre-GK hemifacial spasm. Four patients (16%) developed hydrocephalus post-GK.

Conclusion:

GK stereotactic radiosurgery as a primary treatment modality for large VS can provide acceptable tumor control rates with good facial nerve and hearing preservation, and low complication rates.

Résumé:

Résumé:Objectif:

Le but de l'étude était de revoir notre expérience institutionnelle de l'utilisation de la radiochirurgie stétéotaxique par scalpel gamma (SG) dans le traitement des schwannomes vestibulaires (SV) de grande taille, soit de 3 à 4 cm de diamètre.

Méthode:

Nous avons effectué une revue rétrospective de cohorte de tous les patients traités par SG pour un SV dans notre institution entre novembre 2003 et mars 2012. Les données sur l'âge, le sexe, le volume du SV, sa localisation et son diamètre maximal, les scores à l'échelle de House-Backmann (HB) pour le nerf facial avant et après traitement par le SG, le score à l'échelle de Gardner-Robertson (GR) pour l'audition avant et après traitement par le SG, les paramètres de traitement par le SG, le temps de réponse du SV, les complications et l'issue clinique ont été colligés.

Résultats:

Nous avons identifié 28 patients qui ont été traités pendant cette période. Trois patients ont été perdus de vue. Le suivi moyen des patients était de 34,5 mois. Un contrôle de la tumeur a été constaté chez 92% des patients et il était maintenu après 2 ans de suivi chez 85,7% des patients. L'intégrité du nerf facial ou de l'audition était préservée chez les patients traités par rapport à leur état préSG, selon les échelles HB et GR. Des complications transitoires sont survenues chez 80% des patients. Une dysfonction vestibulaire temporaire a été observée chez 7 patients (28%). Un patient (4%) a présenté une complication permanente, soit une aggravation d'un spasme hémifacial préexistant. Quatre patients (16%) ont présenté une hydrocéphalie postSG.

Conclusion:

La radiochirurgie stéréotaxique par le SG comme modalité de traitement initial pour un SV de grande taille offre des taux acceptables de contrôle de la tumeur avec une bonne préservation du nerf facial et de l'audition et un faible taux de complications.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 3 , May 2013 , pp. 342 - 347
Copyright
Copyright © The Canadian Journal of Neurological 2013

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