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

Toshinori Hasegawa M.D.1, Yoshihisa Kida M.D.1, Tatsuya Kobayashi M.D.1, Masayuki Yoshimoto M.D.1, Yoshimasa Mori M.D.1, and Jun Yoshida M.D.1
View More View Less
  • 1 Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki; and Department of Neurosurgery, Nagoya University, Nagoya, Japan
Page Range:
10–16
Volume/Issue:
Volume 102: Issue 1
DOI link:
https://doi.org/10.3171/jns.2005.102.1.0010
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

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.

Volume 102: Issue 1 (Jan 2005)

in Journal of Neurosurgery
Cover Journal of Neurosurgery

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
USD  $515.00
USD  $612.00
Print or Print + Online

Contributor Notes

Address reprint requests to: Toshinori Hasegawa, M.D., Department of Neurosurgery, Komaki City Hospital, Gamma Knife Center, 1-20 Jobushi, Komaki, Aichi Prefecture 485-8520, Japan. email: h-toshi@komakihp.gr.jp.
  • 1.

    Cerullo LJ, , Grutsch JF, , Heiferman K, & Osterdock R: The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma). Surg Neurol 39:485–493, 1993 Cerullo LJ, Grutsch JF, Heiferman K, Osterdock R: The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma). Surg Neurol 39:485–493, 1993

    • Search Google Scholar
    • Export Citation
  • 2.

    Flickinger JC, , Kondziolka D, & Lunsford LD: Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery. Radiother Oncol 41:215–219, 1996 Flickinger JC, Kondziolka D, Lunsford LD: Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery. Radiother Oncol 41:215–219, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Flickinger JC, , Kondziolka D, , Niranjan A, & Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94:1–6, 2001 Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94:1–6, 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Flickinger JC, , Lunsford LD, , Linskey ME, , Duma CM, & Kondziolka D: Gamma knife radiosurgery for acoustic tumors multivariate analysis of four year results. Radiother Oncol 27:91–98, 1993 Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondziolka D: Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results. Radiother Oncol 27:91–98, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Foote RL, , Coffey RJ, , Swanson JW, , Harner SG, , Beatty CW, & Kline RW, et al: Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:1153–1160, 1995 Foote RL, Coffey RJ, Swanson JW, Harner SG, Beatty CW, Kline RW, et al: Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:1153–1160, 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Gardner G, & Robertson JH: Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66, 1988 Gardner G, Robertson JH: Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66, 1988

    • Search Google Scholar
    • Export Citation
  • 7.

    Hanabusa K, , Morikawa A, , Murata T, & Taki W: Acoustic neuroma with malignant transformation. Case report. J Neurosurg 95:518–521, 2001 Hanabusa K, Morikawa A, Murata T, Taki W: Acoustic neuroma with malignant transformation. Case report. J Neurosurg 95:518–521, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Horstmann GA, & Van Eck AT: Gamma knife model C with automatic positioning system and its impact on the treatment of vestibular schwannomas. J Neurosurg 97 (Suppl 5):450–455, 2002 Horstmann GA, Van Eck AT: Gamma knife model C with automatic positioning system and its impact on the treatment of vestibular schwannomas. J Neurosurg 97 (Suppl 5):450–455, 2002

    • Search Google Scholar
    • Export Citation
  • 9.

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147, 1985 House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Ito K, , Kurita H, , Sugasawa K, , Mizuno M, & Sasaki T: Analyses of neuro-otological complications after radiosurgery for acoustic neurinomas. Int J Radiat Oncol Biol Phys 39:983–988, 1997 Ito K, Kurita H, Sugasawa K, Mizuno M, Sasaki T: Analyses of neuro-otological complications after radiosurgery for acoustic neurinomas. Int J Radiat Oncol Biol Phys 39:983–988, 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Iwai Y, , Yamanaka K, , Shiotani M, & Uyama T: Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282–288, 2003 Iwai Y, Yamanaka K, Shiotani M, Uyama T: Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282–288, 2003

    • Search Google Scholar
    • Export Citation
  • 12.

    Karpinos M, , Teh BS, , Zeck O, , Carpenter LS, , Phan C, & Mai WY, et al: Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410–1421, 2002 Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, et al: Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410–1421, 2002

    • Search Google Scholar
    • Export Citation
  • 13.

    Kondziolka D, , Lunsford LD, , Mclaughlin MR, & Flickinger JC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433, 1998 Kondziolka D, Lunsford LD, Mclaughlin MR, Flickinger JyC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433, 1998

    • Search Google Scholar
    • Export Citation
  • 14.

    Kondziolka D, , Nathoo N, , Flickinger JC, , Niranjan A, , Maitz AH, & Lunsford LD: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:815–822, 2003 Kondziolka D, Nathoo N, Flickinger JC, Niranjan A, Maitz AH, Lunsford LD: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:815–822, 2003

    • Search Google Scholar
    • Export Citation
  • 15.

    Lee F, , Linthicum F Jr, & Hung G: Proliferation potential in recurrent acoustic schwannoma following gamma knife radiosurgery versus microsurgery. Laryngoscope 112:948–950, 2002 Lee F, Linthicum F Jr, Hung G: Proliferation potential in recurrent acoustic schwannoma following gamma knife radiosurgery versus microsurgery. Laryngoscope 112:948–950, 2002

    • Search Google Scholar
    • Export Citation
  • 16.

    Linskey ME, , Lunsford LD, & Flickinger JC: Radiosurgery for acoustic neurinomas: early experience. Neurosurgery 26:736–745, 1990 Linskey ME, Lunsford LD, Flickinger JC: Radiosurgery for acoustic neurinomas: early experience. Neurosurgery 26:736–745, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Mazzoni A, , Calabrese V, & Moschini L: Residual and recurrent acoustic neurinoma in hearing preservation procedures: neuroradiologic and surgical findings. Skull Base Surg 6:105–112, 1996 Mazzoni A, Calabrese V, Moschini L: Residual and recurrent acoustic neurinoma in hearing preservation procedures: neuroradiologic and surgical findings. Skull Base Surg 6:105–112, 1996

    • Search Google Scholar
    • Export Citation
  • 18.

    Meijer OWM, , Vandertop WP, , Baayen JC, & Slotman BJ: Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396, 2003 Meijer OWM, Vandertop WP, Baayen JC, Slotman BJ: Singlefraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396, 2003

    • Search Google Scholar
    • Export Citation
  • 19.

    Niranjan A, , Lunsford LD, , Flickinger JC, , Maitz A, & Kondziolka D: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753–765, 1999 Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753–765, 1999

    • Search Google Scholar
    • Export Citation
  • 20.

    Noren G: Gamma knife radiosurgery for acoustic neurinomas, in Gildenberg PL, & Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1998, vol 1, pp 835–844 Noren G: Gamma knife radiosurgery for acoustic neurinomas, in Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1998, vol 1, pp 835–844

    • Search Google Scholar
    • Export Citation
  • 21.

    Noren G, , Karlbom A, , Brantberg K, , Lax I, & Mosskin M: Gamma knife radiosurgery for acoustic neurinomas. Neurosurgeons 14:159–163, 1995 Noren G, Karlbom A, Brantberg K, Lax I, Mosskin M: Gamma knife radiosurgery for acoustic neurinomas. Neurosurgeons 14:159–163, 1995

    • Search Google Scholar
    • Export Citation
  • 22.

    Ogunrinde OK, , Lunsford LD, , Flickinger JC, & Kondziolka D: Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination. J Neurosurg 80:1011–1017, 1994 Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D: Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination. J Neurosurg 80:1011–1017, 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    Petit JH, , Hudes RS, , Chen TT, , Eisenberg HM, , Simard JM, & Chin LS: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:1299–1307, 2001 Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:1299–1307, 2001

    • Search Google Scholar
    • Export Citation
  • 24.

    Prasad D, , Steiner M, & Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745–759, 2000 Prasad D, Steiner M, Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745–759, 2000

    • Search Google Scholar
    • Export Citation
  • 25.

    Regis J, , Hayashi M, , Porcheron D, , Delsanti C, , Muracciole X, & Peragut JC: Impact of the model C and Automatic Positioning System on gamma knife radiosurgery: an evaluation in vestibular schwannomas. J Neurosurg 97 (Suppl 5):588–591, 2002 Regis J, Hayashi M, Porcheron D, Delsanti C, Muracciole X, Peragut JC: Impact of the model C and Automatic Positioning System on gamma knife radiosurgery: an evaluation in vestibular schwannomas. J Neurosurg 97 (Suppl 5):588–591, 2002

    • Search Google Scholar
    • Export Citation
  • 26.

    Regis J, , Pellet W, , Delsanti C, , Dufour H, , Roche PH, & Thomassin JM, et al: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100, 2002 Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, et al: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100, 2002

    • Search Google Scholar
    • Export Citation
  • 27.

    Samii M, & Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–23, 1997 Samii M, Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–23, 1997

    • Search Google Scholar
    • Export Citation
  • 28.

    Sawamura Y, , Shirato H, , Sakamoto T, , Aoyama H, , Suzuki K, & Onimaru R, et al: Management of vestibular schwannoma by fractionated stereotatic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99:685–692, 2003 Sawamura Y, Shirato H, Sakamoto T, Aoyama H, Suzuki K, Onimaru R, et al: Management of vestibular schwannoma by fractionated stereotatic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99:685–692, 2003

    • Search Google Scholar
    • Export Citation
  • 29.

    Shin M, , Ueki K, , Kurita H, & Kirino T: Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet 360:309–310, 2002 Shin M, Ueki K, Kurita H, Kirino T: Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet 360:309–310, 2002

    • Search Google Scholar
    • Export Citation
  • 30.

    Unger F, , Walch C, , Schrottner O, , Eustacchio S, , Sutter B, & Pendl G: Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir (Suppl) 84:77–83, 2002 Unger F, Walch C, Schrottner O, Eustacchio S, Sutter B, Pendl G: Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir (Suppl) 84:77–83, 2002

    • Search Google Scholar
    • Export Citation
  • 31.

    Wiegand DA, , Ojemann RG, & Fickel V: Surgical treatment of acoustic neuroma (vestibular schwannoma) in the United States: report from the Acoustic Neuroma Registry. Laryngoscope 106:58–66, 1996 Wiegand DA, Ojemann RG, Fickel V: Surgical treatment of acoustic neuroma (vestibular schwannoma) in the United States: report from the Acoustic Neuroma Registry. Laryngoscope 106:58–66, 1996

    • Search Google Scholar
    • Export Citation
  • 32.

    Williams JA: Fractionated stereotactic radiotherapy for acoustic neuromas. Acta Neurochir 144:1249–1254, 2002 Williams JA: Fractionated stereotactic radiotherapy for acoustic neuromas. Acta Neurochir 144:1249–1254, 2002

    • Search Google Scholar
    • Export Citation
  • 33.

    Yamakami I, , Uchino Y, , Kobayashi E, & Yamaura A: Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res 25:682–690, 2003 Yamakami I, Uchino Y, Kobayashi E, Yamaura A: Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res 25:682–690, 2003

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 779 149 17
Full Text Views 238 33 4
PDF Downloads 117 32 5
EPUB Downloads 0 0 0