Radiosurgery of vestibular schwannomas: summary of experience in 829 cases

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 195-199 ◽  
Author(s):  
L. Dade Lunsford ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
Ann Maitz ◽  
Douglas Kondziolka
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Content Type ◽  
Dose Planning ◽  
Fine Print

Object. Management options for vestibular schwannomas (VSs) have greatly expanded since the introduction of stereotactic radiosurgery. Optimal outcomes reflect long-term tumor control, preservation of cranial nerve function, and retention of quality of life. The authors review their 15-year experience. Methods. Between 1987 and 2002, some 829 patients with VSs underwent gamma knife surgery (GKS). Dose selection, imaging, and dose planning techniques evolved between 1987 and 1992 but thereafter remained stable for 10 years. The average tumor volume was 2.5 cm3. The median margin dose to the tumor was 13 Gy (range 10–20 Gy). No patient sustained significant perioperative morbidity. The average duration of hospital stay was less than 1 day. Unchanged hearing preservation was possible in 50 to 77% of patients (up to 90% in those with intracanalicular tumors). Facial neuropathy risks were reduced to less than 1%. Trigeminal symptoms were detected in less than 3% of patients whose tumors reached the level of the trigeminal nerve. Tumor control rates at 10 years were 97% (no additional treatment needed). Conclusions. Superior imaging, multiple isocenter volumetric conformal dose planning, and optimal precision and dose delivery contributed to the long-term success of GKS, including in those patients in whom initial microsurgery had failed. Gamma knife surgery provides a low risk, minimally invasive treatment option for patients with newly diagnosed or residual VS. Cranial nerve preservation and quality of life maintenance are possible in long-term follow up.

Radiosurgery of vestibular schwannomas: summary of experience in 829 cases

2005 ◽  
Vol 102 ◽  
pp. 195-199 ◽  
Author(s):  
L. Dade Lunsford ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
Ann Maitz ◽  
Douglas Kondziolka
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Content Type ◽  
Dose Planning ◽  
Fine Print

Object.Management options for vestibular schwannomas (VSs) have greatly expanded since the introduction of stereotactic radiosurgery. Optimal outcomes reflect long-term tumor control, preservation of cranial nerve function, and retention of quality of life. The authors review their 15-year experience.Methods.Between 1987 and 2002, some 829 patients with VSs underwent gamma knife surgery (GKS). Dose selection, imaging, and dose planning techniques evolved between 1987 and 1992 but thereafter remained stable for 10 years. The average tumor volume was 2.5 cm3. The median margin dose to the tumor was 13 Gy (range 10–20 Gy).No patient sustained significant perioperative morbidity. The average duration of hospital stay was less than 1 day. Unchanged hearing preservation was possible in 50 to 77% of patients (up to 90% in those with intracanalicular tumors). Facial neuropathy risks were reduced to less than 1%. Trigeminal symptoms were detected in less than 3% of patients whose tumors reached the level of the trigeminal nerve. Tumor control rates at 10 years were 97% (no additional treatment needed).Conclusions.Superior imaging, multiple isocenter volumetric conformal dose planning, and optimal precision and dose delivery contributed to the long-term success of GKS, including in those patients in whom initial microsurgery had failed. Gamma knife surgery provides a low risk, minimally invasive treatment option for patients with newly diagnosed or residual VS. Cranial nerve preservation and quality of life maintenance are possible in long-term follow up.

Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 90-92 ◽  
Author(s):  
Mark E. Linskey
Keyword(s):  
Gamma Knife ◽  
Stereotactic Radiotherapy ◽  
Three Dimensional ◽  
Late Recurrence ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Content Type ◽  
Single Fraction ◽  
Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

The long-term results of gamma knife radiosurgery for hemangioblastomas of the brain

2005 ◽  
Vol 102 ◽  
pp. 225-229 ◽  
Author(s):  
En-Min Wang ◽  
Li Pan ◽  
Bing-Jiang Wang ◽  
Nan Zhang ◽  
Liang-Fu Zhou ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Control ◽  
Content Type ◽  
Prescription Dose ◽  
The Mean ◽  
Vhl Disease ◽  
The Brain ◽  
Fine Print

Object. The authors assessed the long-term result of gamma knife surgery (GKS) for hemangioblastomas of the brain (HABs) and show histopathological findings after GKS. Methods. Thirty-five patients, 28 men and seven women, with a mean age of 36 years underwent GKS. Eighteen patients presented with multiple tumors and 17 with a solitary tumor. Twenty-one patients had von Hippel—Lindau (VHL) disease. The mean tumor diameter was 13 mm (range 5–55 mm). The mean follow up after GKS was 66 months (range 24–114 months). The mean prescription dose was 17.2 Gy (range 12–24 Gy) at the tumor margin. For tumors close to or within the brainstem a prescription dose of 12 to 13 Gy was used. At the most recent follow up, 29 patients were alive, six were dead, and satisfactory tumor control had been achieved in 29. A stable or improved neurological status was obtained in 21 patients. Eight patients underwent open surgery because of tumor-associated cyst enlargement or the development of new tumors after GKS. Seven patients developed new tumors and five of them required a second GKS. The 1-year tumor control rate was 94%; 2 years, 85%; 3 years, 82%; 4 years, 79%; and 5 years, 71%. Histopathology showed that no tumor cells were found and there was degeneration and necrosis in a tumor nodule 48 months after GKS with a prescription dose of 18 Gy. Conclusions. Gamma knife surgery was a useful choice for small- or medium-sized, solid HAB in the long term, especially when the tumor margin dose was 18 Gy. Although GKS can treat multiple tumors in a single session, for HABs associated with VHL disease, GKS faces the dual problems of tumor recurrence or development of a new tumor.

Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease

2005 ◽  
Vol 103 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Kelly E. Lyons ◽  
Rajesh Pahwa
Keyword(s):  
Quality Of Life ◽  
Parkinson Disease ◽  
Motor Function ◽  
Well Being ◽  
Strongly Correlated ◽  
Content Type ◽  
Fine Print

Object. The goals of this study were to evaluate long-term benefits in quality of life in patients with Parkinson disease (PD) after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and to evaluate the relationship between improvements in motor function and quality of life. Methods. Seventy-one patients who received bilateral STN stimulation implants and participated in follow-up review for at least 12 months were included in the study. Fifty-nine patients participated in a 12-month follow-up review and 43 patients in a follow-up review lasting at least 24 months. Patients' symptoms were assessed preoperatively by using the Unified PD Rating Scale (UPDRS) in the “medication-on” and “medication-off” conditions and quality of life was examined using the 39-item PD Questionnaire (PDQ-39). Patient evaluations were repeated postoperatively during periods of stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as the PDQ-39 total, mobility, ADL, emotional well-being, stigma, and bodily discomfort scores were significantly improved at 12 months compared with baseline scores; the UPDRS ADL and motor scores as well as the PDQ-39 total, mobility, ADL, stigma, and bodily discomfort scores were significantly improved at the longest follow-up examination compared with baseline scores. There was a strong correlation between UPDRS motor and ADL scores and the PDQ-39 total, mobility, and ADL scores. Further analyses indicated that improvements in tremor were only correlated with PDQ-39 ADL subscale scores and rigidity was not correlated with any aspect of quality of life. Nevertheless, bradykinesia was strongly correlated with improvements in the PDQ-39 total, mobility, and ADL scores. Conclusions. Improvements in quality of life following bilateral DBS of the STN are maintained in the long term. These improvements are strongly correlated with improvements in motor function, primarily with regard to bradykinesia.

Impact on the quality of life of patients with arteriovenous malformations during the latent interval between gamma knife radiosurgery and lesion obliteration

2002 ◽  
Vol 97 ◽  
pp. 471-473 ◽  
Author(s):  
Erica Ho Pik Lai ◽  
Samuel Leung Cheong Lun
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Medical Problems ◽  
Waiting Period ◽  
Content Type ◽  
Latent Interval ◽  
Fine Print

Object. The aim of this study was to measure the quality of life (QOL) in patients with cerebral arteriovenous malformations (AVMs) receiving gamma knife treatment before total AVM obliteration. Quality of life was assessed as it related to the knowledge of rebleeding risk during the waiting period, AVM symptoms, and previous bleeding. Methods. Thirty-nine patients age 18 years or older without other medical problems were asked to complete a questionnaire that included demographic variables, immediate effect of gamma knife radiosurgery, symptoms of AVM, previous hemorrhage, and the Duke—University of North Carolina Health Profile (63 items). Conclusions. The QOL of patients with cerebral AVM during the waiting period after undergoing gamma knife treatment was affected by irreversible physical disabilities rather than the knowledge of hemorrhage risk and bleeding experience.

Gamma Knife Radiosurgery for Low-Grade Gliomas: Clinical Results at Long-Term Follow-Up of Tumor Control and Patients' Quality of Life

2017 ◽  
Vol 101 ◽  
pp. 540-553 ◽  
Author(s):  
Filippo Gagliardi ◽  
Michele Bailo ◽  
Alfio Spina ◽  
Carmine A. Donofrio ◽  
Nicola Boari ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Clinical Results ◽  
Tumor Control ◽  
Low Grade ◽  
Long Term Follow Up

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.

Gamma knife radiosurgery and brain metastases: local control, survival, and quality of life

2002 ◽  
Vol 97 ◽  
pp. 507-510 ◽  
Author(s):  
Theodor S. Vesagas ◽  
Jose A. Aguilar ◽  
Eduardo R. Mercado ◽  
Manuel M. Mariano
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Median Survival ◽  
Local Control ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Control Survival ◽  
Fine Print

Object. The purpose of this paper was to describe the clinical outcome in patients with brain metastases who underwent gamma knife radiosurgery (GKS). Methods. The authors retrospectively reviewed the clinical courses of 54 patients with brain metastases who underwent 62 GKS procedures. This series covered a 43-month period. A total of 174 lesions were treated: 38 patients harbored solitary whereas 24 patients harbored multiple metastases. The authors assessed outcome by examining local disease control, survival, and quality of life. The overall local control rate was 85%; the mean time to failure of local control was 10.5 months; and median survival was 8.4 months. Median survival, evaluated by the log-rank test, was greater among patients with a single metastasis (p = 0.043), breast cancer (p = 0.021), and those who had undergone multiple GKS procedures for local failure (p = 0.009). The initial Karnofsky Performance Scale (KPS) score and whole-brain radiotherapy were not significantly related to median survival. The KPS scores tended to remain stable through the follow-up period. There were no morbidities or deaths attributable to the procedure. Conclusions. Results in this series suggest that GKS can be an effective tool for the control of brain metastases. A prospective investigation should be performed to validate trends seen in this retrospective study.

Long-term health-related quality of life outcomes following Jefferson-type burst fractures of the atlas

2005 ◽  
Vol 2 (4) ◽  
pp. 411-417 ◽  
Author(s):  
Marcel F. Dvorak ◽  
Michael G. Johnson ◽  
Michael Boyd ◽  
Garth Johnson ◽  
Brian K. Kwon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Related Quality ◽  
Content Type ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Fine Print

Object. The primary goal of this study was to describe the long-term health-related quality of life (HRQOL) outcomes in patients who have suffered Jefferson-type fractures. These outcomes were compared with matched normative HRQOL data and with the patient's perceptions of their HRQOL prior to the injury. Variables that potentially influence these HRQOL outcomes were analyzed. No standardized outcome assessments have been published for patients who suffer these fractures; their outcomes have long thought to be excellent following treatment. Determining the optimal surrogate measure to represent preinjury HRQOL in trauma patients is difficult. Methods. A retrospective review, radiographic analysis, and cross-sectional outcome assessment were performed. The Short Form (SF)—36 and the American Academy of Orthopaedic Surgeons/North American Spine Society (AAOS/NASS) outcome instruments were filled out by patients at final follow-up examination (follow-up period 75 months, range 19–198 months) to represent their current status as well as their perceptions of preinjury status. In 34 patients, the SF-36 physical component score and the AAOS/NASS pain values were significantly lower than normative values. There was no significant difference between normative and preinjury values. Spence criteria greater than 7 mm and the presence of associated injuries predicted poorer outcome scores during the follow-up period. Conclusions. Long-term follow-up examination of patients with Jefferson fractures indicated that patients' status does not return to the level of their perceived preinjury health status or that of normative population controls. Those with other injuries and significant osseous displacement (≥ 7 mm total) may experience poorer long-term outcomes. Limitations of the study included a relatively low (60%) response rate and the difficulties of identifying an appropriate baseline outcome in a trauma population with which the follow-up outcomes can be compared.

The long-term results of gamma knife radiosurgery for hemangioblastomas of the brain

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 225-229 ◽  
Author(s):  
En-Min Wang ◽  
Li Pan ◽  
Bing-Jiang Wang ◽  
Nan Zhang ◽  
Liang-Fu Zhou ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Control ◽  
Content Type ◽  
Prescription Dose ◽  
The Mean ◽  
Vhl Disease ◽  
The Brain ◽  
Fine Print

Object. The authors assessed the long-term result of gamma knife surgery (GKS) for hemangioblastomas of the brain (HABs) and show histopathological findings after GKS. Methods. Thirty-five patients, 28 men and seven women, with a mean age of 36 years underwent GKS. Eighteen patients presented with multiple tumors and 17 with a solitary tumor. Twenty-one patients had von Hippel—Lindau (VHL) disease. The mean tumor diameter was 13 mm (range 5–55 mm). The mean follow up after GKS was 66 months (range 24–114 months). The mean prescription dose was 17.2 Gy (range 12–24 Gy) at the tumor margin. For tumors close to or within the brainstem a prescription dose of 12 to 13 Gy was used. At the most recent follow up, 29 patients were alive, six were dead, and satisfactory tumor control had been achieved in 29. A stable or improved neurological status was obtained in 21 patients. Eight patients underwent open surgery because of tumor-associated cyst enlargement or the development of new tumors after GKS. Seven patients developed new tumors and five of them required a second GKS. The 1-year tumor control rate was 94%; 2 years, 85%; 3 years, 82%; 4 years, 79%; and 5 years, 71%. Histopathology showed that no tumor cells were found and there was degeneration and necrosis in a tumor nodule 48 months after GKS with a prescription dose of 18 Gy. Conclusions. Gamma knife surgery was a useful choice for small- or medium-sized, solid HAB in the long term, especially when the tumor margin dose was 18 Gy. Although GKS can treat multiple tumors in a single session, for HABs associated with VHL disease, GKS faces the dual problems of tumor recurrence or development of a new tumor.

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