Should Koos grade I vestibular schwannomas be treated early with gamma knife surgery? A subgroup analysis in a series of 190 consecutive patients

2014 ◽  
Vol 60 (6) ◽  
pp. 331
Author(s):  
M. Levivier ◽  
C. Tuleasca ◽  
G. Mercy ◽  
L. Schiappacasse ◽  
M. Zeverino ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Subgroup Analysis ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas

scholarly journals Letter to the Editor Regarding “Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes”

2019 ◽  
Vol 122 ◽  
pp. 719-721 ◽  
Author(s):  
Constantin Tuleasca ◽  
Roy Thomas Daniel ◽  
Daniele Starnoni ◽  
Mercy George ◽  
Raphael Maire ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Letter To The Editor

Gamma knife surgery in the treatment of intracanalicular vestibular schwannomas

2020 ◽  
Vol 141 (5) ◽  
pp. 415-422 ◽  
Author(s):  
Sebastian Dzierzęcki ◽  
Grzegorz Turek ◽  
Bartosz Czapski ◽  
Katarzyna Dyttus‐Cebulok ◽  
Ryszard Tomasiuk ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas

Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes

2018 ◽  
Vol 118 ◽  
pp. e895-e905 ◽  
Author(s):  
Lucas Troude ◽  
Mohamed Boucekine ◽  
Marion Montava ◽  
Jean-Pierre Lavieille ◽  
Jean-Marie Régis ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas

scholarly journals Gamma Knife Stereotactic Radiosurgery (GKS) for the treatment of Vestibular Schwannomas (VS)

2015 ◽  
Vol 10 (2) ◽  
pp. 143-147
Author(s):  
R. PERIN ◽  
◽  
A. MOHAN ◽  
H. MOISA ◽  
A.V. CIUREA ◽  
...  
Keyword(s):  
Nervous System ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Vestibular Schwannomas ◽  
Response To Treatment ◽  
Benign Tumors ◽  
Acoustic Neuromas ◽  
The Impact

Introduction. Vestibular schwannomas (VS) or acoustic neuromas (AN) (as they are known to neurosurgeons) are benign tumors which originate at the junction between central nervous system myelin and peripheral nervous system myelin – an area known as the Obersteiner-Redlich area. Acoustic neuromas represent a special pathologic entity for neurosurgeons due to their important symptoms which need to be adressed as soon as possible and due to the secondary disfunctions which may appear if the tumors are not treated appropriately. Materials and methods. The study below presents the experience of the authors regarding the use of stereotactic radiosurgery for the treatment of acoustic neuromas. The authors focus on a population of 231 patients diagnosed and treated for VS over a period of 10 years at the „Bagdasar-Arseni“ University Hospital in Bucharest. This study compares the impact of Gamma Knife Surgery when performed alone or in association with open microneurosurgery. The authors assessed patients with tumors ranging between 0.25 and 14 cm3 in volume. Gamma Knife Surgery is used successfully to treat VS, both independantly or in association with open microsurgery. Results. The major complications of the treatment are represented by lack of response to treatment (less than 1% of patients) and cerebral edema (16.4% of patients). Conclusions. Given its multiple advantages, stereotactic radiosurgery is right now the tip of the spear regarding the therapeutical means available for VS. When the tumors met in daily practice are larger than the therapeutical resources of the devices used for Gamma Knife Surgery an open microsurgical approach may be attempted followed by stereotactic iradiation of the remnant tumor. Given the large number of successes reported in the literature and the small number of complications but also the ever progressing technology used to improve Gamma Knife devices, the authors consider stereotactic radiosurgery to be a very good solution for the treatment of VS. Furthermore, the improvement potential this technique has grants it the potential to improve standard of treatment for acoustic neuromas and the quality of life in patients with this disease.

Tumor shrinkage of vestibular schwannomas after Gamma Knife surgery: results after more than 5 years of follow-up

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 122-127 ◽  
Author(s):  
Osamu Nagano ◽  
Toru Serizawa ◽  
Yoshinori Higuchi ◽  
Shinji Matsuda ◽  
Makoto R.T. Sato ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Volume Expansion ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Mr Images ◽  
Volume Changes ◽  
Cardiovascular Center ◽  
The Mean

Object The authors prospectively analyzed volume changes in vestibular schwannomas (VSs) after Gamma Knife surgery (GKS). Methods Among 104 VSs treated by GKS at the Chiba Cardiovascular Center between 1998 and 2004, 87 consecutively treated unilateral VSs observed on follow-up MR imaging for at least 5 years were analyzed. These lesions were harbored by 31 men and 56 women, with a mean age of 58.6 years (range 29–80 years). The Gd-enhanced volume of each lesion was measured serially every 3 months during the 1st year and every 6 months thereafter using GammaPlan or SurgiPlan. The frequency and degree of volume shrinkage were documented and possible prognostic factors were analyzed. Results The mean tumor volume at GKS was 2.5 cm3 (range 0.1–13.2 cm3). The lesions were irradiated by directing a mean dose of 12.0 Gy (range 10.5–13.0 Gy) to the tumor margin, which was located at the mean 52.2% isodose line (range 50%–67% isodose line). The mean follow-up period was 7.5 years (range 5.0–11.1 years). Peak tumor volume expansion was most frequently observed at 8.6 months after GKS and averaged 58% (range 0%–613%). Five years after GKS, the mean reduction in tumor volume was 31%, and 9 tumors still remained larger than their initial volumes. Tumors that homogeneously enhanced on MR images displayed less shrinkage than other tumors. Conclusions Most VSs exhibit shrinkage 5 years after GKS. The mean volume reduction in this series was 31%. These results indicate that careful serial follow-up is necessary for patients who harbor tumors that display homogeneous enhancement on MR images and patients whose tumors continue to expand in size after GKS.

Retreatment of vestibular schwannomas with Gamma Knife surgery

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 144-148 ◽  
Author(s):  
Sheri Dewan ◽  
Georg Norén
Keyword(s):  
Facial Nerve ◽  
New England ◽  
Gamma Knife ◽  
Radiation Effects ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Proton Beam Radiotherapy

Object The response rate of vestibular schwannomas (VSs) to radiosurgery has reached the 97% level in several published series. When failure rarely occurs, some controversy has existed as to whether the tumor has to be resected or can be safely retreated with radiosurgery. The authors retrospectively studied the outcome of retreating 11 patients with Gamma Knife surgery (GKS). Methods The authors studied 11 patients at the New England Gamma Knife Center who had undergone GKS as a second radiosurgical treatment for VS from 1994 to 2007. One patient underwent proton-beam radiotherapy as the first treatment, and the other 10 patients had undergone GKS initially. Tumor control (size before and after the first and the second treatment) was evaluated using MR imaging to demonstrate the course after the 2 treatments. Facial nerve function (House–Brackmann grading system), trigeminal nerve function, hearing (Gardner–Robertson classification), and any adverse radiation effects were evaluated. The prescription dose was 12 Gy (11–13.2 Gy) for both treatments. Results Of the 11 patients, 2 showed increase, 1 had no change, and, in 8, the VS decreased in size after the retreatment. One tumor remained unchanged over the first 6 months, but demonstrated signs of internal necrosis. All patients demonstrated stable facial nerve function. Regarding facial numbness, 2 patients experienced increases, 8 no change, and 1 decreased numbness. There was no functional hearing prior to the second treatment in 10 patients, and hearing was impaired in 1 patient. Adverse radiation effects (slight peduncular edema) were seen in 2 patients after the second treatment, and 1 patient had edema after the first treatment as well. Conclusions Vestibular schwannomas can be retreated with GKS with good tumor control response and low risk of toxicity.

Does NF2 status impact the results of combined surgery and adjunctive Gamma Knife surgery for large vestibular schwannomas?

2019 ◽  
Vol 43 (4) ◽  
pp. 1191-1199 ◽  
Author(s):  
Lucas Troude ◽  
Mohamed Boucekine ◽  
Marion Montava ◽  
Anne Balossier ◽  
Jean-Pierre Lavieille ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Combined Surgery

REPEAT GAMMA KNIFE SURGERY FOR REGROWTH OF VESTIBULAR SCHWANNOMAS

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Shoji Yomo ◽  
Yasser Arkha ◽  
Christine Delsanti ◽  
Pierre-Hugue Roche ◽  
Jean-Marc Thomassin ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Neurological Deficits ◽  
Invasive Treatment ◽  
Hearing Ability ◽  
Long Term Follow Up

Abstract OBJECTIVE Gamma knife surgery (GKS) has become established as a minimally invasive treatment modality for patients with vestibular schwannomas. Treatment failure and/or tumor regrowth, however, is occasionally encountered, and microsurgical resection is usually warranted in such cases. The role of repeat GKS in these situations is still unclear. The goal of this study was to investigate whether repeat GKS is an effective treatment for recurrent vestibular schwannomas and to assess the conservation of residual neurological function. METHODS Between July 1992 and December 2007, 1951 patients harboring a unilateral vestibular schwannoma were treated with GKS. Of these, 48 patients (2.5%) had to undergo a subsequent intervention because of progression or regrowth of the tumor. Repeat GKS was performed in a total of 15 patients, 8 of whom had more than 2 years of follow-up and were eligible to be enrolled in the present study. The median follow-up period after repeat GKS was 64 months, and the median interval between these interventions was 46 months. The median tumor volume was 0.51 and 1.28 mL at the initial and second GKS treatments, respectively. Patients received a median prescription dose of 12.0 Gy at both interventions. RESULTS We report no cases of failure. Six patients demonstrated a significant reduction in tumor volume. In 1 patient, the final tumor volume was less than the initial volume. The other 2 patients showed stabilization of tumor growth. Useful hearing ability was preserved in only 1 of the 3 patients who had serviceable hearing ability at the time of the second GKS. Neither aggravation of facial nerve dysfunction nor other neurological deficits secondary to GKS were observed. CONCLUSION This is the first report to address repeat GKS for vestibular schwannomas. After long-term follow-up, repeat GKS with a low marginal dose seems to be a safe and effective treatment in selected patients harboring regrowth of small vestibular schwannomas that have previously been treated with GKS.

Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up

2005 ◽  
Vol 102 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Yoshihisa Kida ◽  
Tatsuya Kobayashi ◽  
Masayuki Yoshimoto ◽  
Yoshimasa Mori ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Long Term Outcomes ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Gamma knife surgery (GKS) has been a safe and effective treatment for vestibular schwannomas in both the short and long term, although less is known about long-term outcomes in the past 10 years. The aim of this study was to clarify long-term outcomes in patients with vestibular schwannomas treated using GKS based on techniques in place in the early 1990s. Methods. Eighty patients harboring a vestibular schwannoma (excluding neurofibromatosis Type 2) were treated using GKS between May 1991 and December 1993. Among these, 73 patients were assessed; seven were lost to follow up. The median duration of follow up was 135 months. The mean patient age at the time of GKS was 56 years old. The mean tumor volume was 6.3 cm3, and the mean maximal and marginal radiation doses applied to the tumor were 28.4 and 14.6 Gy, respectively. Follow-up magnetic resonance images were obtained in 71 patients. Forty-eight patients demonstrated partial tumor remission, 14 had tumors that remained stable, and nine demonstrated tumor enlargement or radiation-induced edema requiring resection. Patients with larger tumors did not fare as well as those with smaller lesions. The actuarial 10-year progression-free survival rate was 87% overall, and 93% in patients with tumor volumes less than 10 cm3. No patient experienced malignant transformation. Conclusions. Gamma knife surgery remained an effective treatment for vestibular schwannomas for longer than 10 years. Although treatment failures usually occurred within 3 years after GKS, it is necessary to continue follow up in patients to reveal delayed tumor recurrence.

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