Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience

View More View Less
  • 1 Gamma Knife Center Munik, and Departments of Neurosurgery and Ear, Nose, and Throat Surgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany
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
Print or Print + Online

Object. The purpose of the study was to define the therapeutic profile of outpatient gamma knife surgery (GKS) for vestibular schwannoma (VS) by using sequential tumor volumetry to quantify changes following treatment.

Methods. A total of 111 patients met the inclusion criteria. The median follow-up duration was 7 years (range 5–9.6 years). Thirty-seven patients (33%) had undergone surgery before GKS and 10 (9%) had neurofibromatosis Type 2 (NF2). The median VS volume was 1.6 cm3 (range 0.08–8.7 cm3).

The actuarial 6-year tumor control rate after a single GKS treatment was 95%. Tumor swelling was observed in 43 patients (38.7%). Recurrence was significantly associated with NF2 (p < 0.003) and the reduced dose (p < 0.03) delivered to these tumors. The incidence of facial nerve neuropathy was mainly determined by surgery prior to GKS (p < 0.0001). Facial nerve radiation toxicity was mild and transient. No permanent facial nerve toxicity was observed. Trigeminal neuropathy occurred in 13 patients, and this was correlated with the VS volume (p < 0.02). The median hearing loss was −10 dB (range + 20 dB to −70 dB). The risk of hearing loss was correlated with age and transient tumor swelling (p < 0.05) but not with dose parameters or NF2.

Conclusions. Outpatient GKS is feasible, effective, and safe. Its therapeutic profile compares favorably with that of microsurgery.

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

USD  $515.00

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

USD  $612.00
  • 1.

    Amadasun JE: The growth of acoustic neurinomas. Arch Otorhinolaryngol 217:99102, 1977 Amadasun JE: The growth of acoustic neurinomas. Arch Otorhinolaryngol 217:99–102, 1977

    • Search Google Scholar
    • Export Citation
  • 2.

    Andrews DW, , Suarez O, & Goldman HW, et al: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:12651278, 2001 Andrews DW, Suarez O, Goldman HW, et al: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:1265–1278, 2001

    • Search Google Scholar
    • Export Citation
  • 3.

    Chang SD, , Poen J, & Hancock SL, et al: Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases. J Neurosurg 89:321325, 1998 Chang SD, Poen J, Hancock SL, et al: Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases. J Neurosurg 89:321–325, 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Charabi S, , Tos M, & Thomsen J, et al: Vestibular schwannoma growth—long-term results. Acta Otolaryngol Suppl 543:710, 2000 Charabi S, Tos M, Thomsen J, et al: Vestibular schwannoma growth—long-term results. Acta Otolaryngol Suppl 543:7–10, 2000

    • Search Google Scholar
    • Export Citation
  • 5.

    Charabi S, , Tos M, & Thomsen J, et al: Vestibular schwannoma growth: the continuing controversy. Laryngoscope 110:17201725, 2000 Charabi S, Tos M, Thomsen J, et al: Vestibular schwannoma growth: the continuing controversy. Laryngoscope 110:1720–1725, 2000

    • Search Google Scholar
    • Export Citation
  • 6.

    Charabi S, , Tos M, & Thomsen JC, et al: [Vestibular schwannoma. A new interpretation of tumor growth]. Ugeskr Laeger 162:54975500, 2000 Charabi S, Tos M, Thomsen JC, et al: [Vestibular schwannoma. A new interpretation of tumor growth]. Ugeskr Laeger 162:5497–5500, 2000

    • Search Google Scholar
    • Export Citation
  • 7.

    Da Cruz MJ, , Moffat DA, & Baguley DM, et al: Does choice of hearing selection criterion and reporting criteria affect the hearing preservation rate in vestibular schwannoma surgery? Otolaryngol Head Neck Surg 121:313317, 1999 Da Cruz MJ, Moffat DA, Baguley DM, et al: Does choice of hearing selection criterion and reporting criteria affect the hearing preservation rate in vestibular schwannoma surgery? Otolaryngol Head Neck Surg 121:313–317, 1999

    • Search Google Scholar
    • Export Citation
  • 8.

    Deen HG, , Ebersold MJ, & Harner SG, et al: Conservative management of acoustic neuroma: an outcome study. Neurosurgery 39:260266, 1996 Deen HG, Ebersold MJ, Harner SG, et al: Conservative management of acoustic neuroma: an outcome study. Neurosurgery 39:260–266, 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Delbrouck C, , Hassid S, & Massager N, et al: Preservation of hearing in vestibular schwannomas treated by radiosurgery using Leksell gamma knife: preliminary report of a prospective Belgian clinical study. Acta Otorhinolaryngol Belg 57:197204, 2003 Delbrouck C, Hassid S, Massager N, et al: Preservation of hearing in vestibular schwannomas treated by radiosurgery using Leksell gamma knife: preliminary report of a prospective Belgian clinical study. Acta Otorhinolaryngol Belg 57:197–204, 2003

    • Search Google Scholar
    • Export Citation
  • 10.

    Flickinger JC: Observation versus early stereotactic radiotherapy of acoustic neuroma: what are you waiting for? Int J Radiat Oncol Biol Phys 44:481482, 1999 Flickinger JC: Observation versus early stereotactic radiotherapy of acoustic neuroma: what are you waiting for? Int J Radiat Oncol Biol Phys 44:481–482, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Flickinger JC, , Kondziolka D, & Niranjan A, et al: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94:16, 2001 Flickinger JC, Kondziolka D, Niranjan A, et al: 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
  • 12.

    Fucci MJ, , Buchman CA, & Brackmann DE, et al: Acoustic tumor growth: implications for treatment choices. Am J Otol 20:495499, 1999 Fucci MJ, Buchman CA, Brackmann DE, et al: Acoustic tumor growth: implications for treatment choices. Am J Otol 20:495–499, 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Fukuoka S, , Oka K, & Seo Y, et al: Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma. Stereotact Funct Neurosurg 70 Suppl 1:8894, 1998 Fukuoka S, Oka K, Seo Y, et al: Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma. Stereotact Funct Neurosurg 70 Suppl 1:88–94, 1998

    • Search Google Scholar
    • Export Citation
  • 14.

    Fuss M, , Debus J, & Lohr F, et al: Conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas. Int J Radiat Oncol Biol Phys 48:13811387, 2000 Fuss M, Debus J, Lohr F, et al: Conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas. Int J Radiat Oncol Biol Phys 48:1381–1387, 2000

    • Search Google Scholar
    • Export Citation
  • 15.

    Graamans K, , Van Dijk JE, & Janssen LW: Hearing deterioration in patients with a non-growing vestibular schwannoma. Acta Otolaryngol 123:5154, 2003 Graamans K, Van Dijk JE, Janssen LW: Hearing deterioration in patients with a non-growing vestibular schwannoma. Acta Otolaryngol 123:51–54, 2003

    • Search Google Scholar
    • Export Citation
  • 16.

    Hirato M, , Inoue H, & Zama A, et al: Gamma Knife radiosurgery for acoustic schwannoma: effects of low radiation dose and functional prognosis. Stereotact Funct Neurosurg 66:134141, 1996 Hirato M, Inoue H, Zama A, et al: Gamma Knife radiosurgery for acoustic schwannoma: effects of low radiation dose and functional prognosis. Stereotact Funct Neurosurg 66:134–141, 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Hoistad DL, , Melnik G, & Mamikoglu B, et al: Update on conservative management of acoustic neuroma. Otol Neurotol 22:682685, 2001 Hoistad DL, Melnik G, Mamikoglu B, et al: Update on conservative management of acoustic neuroma. Otol Neurotol 22:682–685, 2001

    • Search Google Scholar
    • Export Citation
  • 18.

    Howitz MF, , Johansen C, & Tos M, et al: Incidence of vestibular schwannoma in Denmark, 1977–1995. Am J Otol 21:690694, 2000 Howitz MF, Johansen C, Tos M, et al: Incidence of vestibular schwannoma in Denmark, 1977–1995. Am J Otol 21:690–694, 2000

    • Search Google Scholar
    • Export Citation
  • 19.

    Hudgins WR: Patients' attitude about outcomes and the role of gamma knife radiosurgery in the treatment of vestibular schwannomas. Neurosurgery 34:459465, 1994 Hudgins WR: Patients' attitude about outcomes and the role of gamma knife radiosurgery in the treatment of vestibular schwannomas. Neurosurgery 34:459–465, 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Kameyama S, , Tanaka R, & Honda Y, et al: The long-term growth rate of residual acoustic neurinomas. Acta Neurochir 129:127130, 1994 Kameyama S, Tanaka R, Honda Y, et al: The long-term growth rate of residual acoustic neurinomas. Acta Neurochir 129:127–130, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Karpinos M, , Teh BS, & Zeck O, et al: Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:14101421, 2002 Karpinos M, Teh BS, Zeck O, 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
  • 22.

    Kaylie DM, & McMenomey SO: Microsurgery vs gamma knife radiosurgery for the treatment of vestibular schwannomas. Arch Otolaryngol Head Neck Surg 129:903906, 2003 Kaylie DM, McMenomey SO: Microsurgery vs gamma knife radiosurgery for the treatment of vestibular schwannomas. Arch Otolaryngol Head Neck Surg 129:903–906, 2003

    • Search Google Scholar
    • Export Citation
  • 23.

    Kondziolka D, , Lunsford LD, & McLaughlin MR, et al: Long-term outcomes after radiosurgery for acoustic neuromas [see comments]. N Engl J Med 339:14261433, 1998 Kondziolka D, Lunsford LD, McLaughlin MR, et al: Long-term outcomes after radiosurgery for acoustic neuromas [see comments]. N Engl J Med 339:1426–1433, 1998

    • Search Google Scholar
    • Export Citation
  • 24.

    Kwon Y, , Khang SK, & Kim CJ, et al: Radiologic and histopathologic changes after gamma knife radiosurgery for acoustic schwannoma. Stereotact Funct Neurosurg 72:210, 1999 Kwon Y, Khang SK, Kim CJ, et al: Radiologic and histopathologic changes after gamma knife radiosurgery for acoustic schwannoma. Stereotact Funct Neurosurg 72:2–10, 1999

    • Search Google Scholar
    • Export Citation
  • 25.

    Laasonen EM, & Troupp H: Volume growth rate of acoustic neurinomas. Neuroradiology 28:203207, 1986 Laasonen EM, Troupp H: Volume growth rate of acoustic neurinomas. Neuroradiology 28:203–207, 1986

    • Search Google Scholar
    • Export Citation
  • 26.

    Leksell L: A note on the treatment of acoustic tumors. Acta Chir Scand 137:763765, 1971 Leksell L: A note on the treatment of acoustic tumors. Acta Chir Scand 137:763–765, 1971

    • Search Google Scholar
    • Export Citation
  • 27.

    Linskey ME, , Lunsford LD, & Flickinger JC: Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR 12:11651175, 1991 Linskey ME, Lunsford LD, Flickinger JC: Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR 12:1165–1175, 1991

    • Search Google Scholar
    • Export Citation
  • 28.

    Luetje CM: Spontaneous involution of acoustic tumors. Am J Otol 21:393398, 2000 Luetje CM: Spontaneous involution of acoustic tumors. Am J Otol 21:393–398, 2000

    • Search Google Scholar
    • Export Citation
  • 29.

    Mack A, , Czempiel H, & Kreiner HJ, et al: Quality assurance in stereotactic space. A system test for verifying the accuracy of aim in radiosurgery. Med Phys 29:561568, 2002 Mack A, Czempiel H, Kreiner HJ, et al: Quality assurance in stereotactic space. A system test for verifying the accuracy of aim in radiosurgery. Med Phys 29:561–568, 2002

    • Search Google Scholar
    • Export Citation
  • 30.

    Mirz F, , Pedersen CB, & Fiirgaard B, et al: Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977–98. Acta Otolaryngol Suppl 543:3033, 2000 Mirz F, Pedersen CB, Fiirgaard B, et al: Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977–98. Acta Otolaryngol Suppl 543:30–33, 2000

    • Search Google Scholar
    • Export Citation
  • 31.

    Modugno GC, , Pirodda A, & Ferri GG, et al: Small acoustic neuromas: monitoring the growth rate by MRI. Acta Neurochir 141:10631067, 1999 Modugno GC, Pirodda A, Ferri GG, et al: Small acoustic neuromas: monitoring the growth rate by MRI. Acta Neurochir 141:1063–1067, 1999

    • Search Google Scholar
    • Export Citation
  • 32.

    Nakamura H, , Jokura H, & Takahashi K, et al: Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR 21:15401546, 2000 Nakamura H, Jokura H, Takahashi K, et al: Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma. AJNR 21:1540–1546, 2000

    • Search Google Scholar
    • Export Citation
  • 33.

    Niemczyk K, , Vaneecloo FM, & Lecomte MH, et al: Correlation between Ki-67 index and some clinical aspects of acoustic neuromas (vestibular schwannomas). Otolaryngol Head Neck Surg 123:779783, 2000 Niemczyk K, Vaneecloo FM, Lecomte MH, et al: Correlation between Ki-67 index and some clinical aspects of acoustic neuromas (vestibular schwannomas). Otolaryngol Head Neck Surg 123:779–783, 2000

    • Search Google Scholar
    • Export Citation
  • 34.

    Niemczyk K, , Vaneecloo FM, & Lemaitre L, et al: The growth of acoustic neuromas in volumetric radiologic assessment. Am J Otol 20:244248, 1999 Niemczyk K, Vaneecloo FM, Lemaitre L, et al: The growth of acoustic neuromas in volumetric radiologic assessment. Am J Otol 20:244–248, 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Nikolopoulos TP, & O'Donoghue GM: Acoustic neuroma management: an evidence-based medicine approach. Otol Neurotol 23:534541, 2002 Nikolopoulos TP, O'Donoghue GM: Acoustic neuroma management: an evidence-based medicine approach. Otol Neurotol 23:534–541, 2002

    • Search Google Scholar
    • Export Citation
  • 36.

    Niranjan A, , Lunsford LD, & Flickinger JC, et al: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753765, 1999 Niranjan A, Lunsford LD, Flickinger JC, et al: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753–765, 1999

    • Search Google Scholar
    • Export Citation
  • 37.

    Noren G: Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70 Suppl 1:6573, 1998 Noren G: Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70 Suppl 1:65–73, 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Noren G, , Greitz D, & Hirsch A, et al: Gamma knife surgery in acoustic tumors. Acta Neurochir Suppl 58:104107, 1993 Noren G, Greitz D, Hirsch A, et al: Gamma knife surgery in acoustic tumors. Acta Neurochir Suppl 58:104–107, 1993

    • Search Google Scholar
    • Export Citation
  • 39.

    Paddick II: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg (Suppl 3) 93:219222, 2000 Paddick II: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg (Suppl 3) 93:219–222, 2000

    • Search Google Scholar
    • Export Citation
  • 40.

    Pellet W, , Regis J, & Roche PH, et al: Relative indications for radiosurgery and microsurgery for acoustic schwannoma. Adv Tech Stand Neurosurg 28:227284, 2003 Pellet W, Regis J, Roche PH, et al: Relative indications for radiosurgery and microsurgery for acoustic schwannoma. Adv Tech Stand Neurosurg 28:227–284, 2003

    • Search Google Scholar
    • Export Citation
  • 41.

    Petit JH, , Hudes RS, & Chen TT, et al: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:12991307, 2001 Petit JH, Hudes RS, Chen TT, et al: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:1299–1307, 2001

    • Search Google Scholar
    • Export Citation
  • 42.

    Pogodzinski MS, , Harner SG, & Link MJ: Patient choice in treatment of vestibular schwannoma. Otolaryngol Head Neck Surg 130:611616, 2004 Pogodzinski MS, Harner SG, Link MJ: Patient choice in treatment of vestibular schwannoma. Otolaryngol Head Neck Surg 130:611–616, 2004

    • Search Google Scholar
    • Export Citation
  • 43.

    Regis J, , Pellet W, & Delsanti C, et al: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:10911100, 2002 Regis J, Pellet W, Delsanti C, et al: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100, 2002

    • Search Google Scholar
    • Export Citation
  • 44.

    Sakamoto T: [Prognostic factors for hearing preservation following observation-only versus stereotactic irradiation (STI) in patients with acoustic neuroma]. Nippon Jibiinkoka Gakkai Kaiho 101:12501259, 1998 Sakamoto T: [Prognostic factors for hearing preservation following observation-only versus stereotactic irradiation (STI) in patients with acoustic neuroma]. Nippon Jibiinkoka Gakkai Kaiho 101:1250–1259, 1998

    • Search Google Scholar
    • Export Citation
  • 45.

    Sakamoto T, , Shirato H, & Takeichi N, et al: Medication for hearing loss after fractionated stereotactic radiotherapy (SRT) for vestibular schwannoma. Int J Radiat Oncol Biol Phys 50:12951298, 2001 Sakamoto T, Shirato H, Takeichi N, et al: Medication for hearing loss after fractionated stereotactic radiotherapy (SRT) for vestibular schwannoma. Int J Radiat Oncol Biol Phys 50:1295–1298, 2001

    • Search Google Scholar
    • Export Citation
  • 46.

    Sanna M, , Khrais T, & Russo A, et al: Hearing preservation surgery in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol 113:156163, 2004 Sanna M, Khrais T, Russo A, et al: Hearing preservation surgery in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol 113:156–163, 2004

    • Search Google Scholar
    • Export Citation
  • 47.

    Seo Y, , Fukuoka S, & Nakagawara J, et al: Effect of gamma knife radiosurgery on acoustic neurinomas. Assessment by 99mTc-DTPA-human serum albumin-and 201TlCl-single photon emission computed tomography. Stereotact Funct Neurosurg 66:93102, 1996 Seo Y, Fukuoka S, Nakagawara J, et al: Effect of gamma knife radiosurgery on acoustic neurinomas. Assessment by 99mTc-DTPA-human serum albumin-and 201TlCl-single photon emission computed tomography. Stereotact Funct Neurosurg 66:93–102, 1996

    • Search Google Scholar
    • Export Citation
  • 48.

    Strasnick B, , Glasscock ME, 3rd, & Haynes D, et al: The natural history of untreated acoustic neuromas. Laryngoscope 104:11151119, 1994 Strasnick B, Glasscock ME, 3rd, Haynes D, et al: The natural history of untreated acoustic neuromas. Laryngoscope 104:1115–1119, 1994

    • Search Google Scholar
    • Export Citation
  • 49.

    Tang BH: Vestibular schwannoma growth. J Neurosurg 100:734735; author reply 735, 2004 Tang BH: Vestibular schwannoma growth. J Neurosurg 100:734–735; author reply 735, 2004

    • Search Google Scholar
    • Export Citation
  • 50.

    Tos M, , Stangerup SE, & Caye-Thomasen P, et al: What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130:216220, 2004 Tos M, Stangerup SE, Caye-Thomasen P, et al: What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130:216–220, 2004

    • Search Google Scholar
    • Export Citation
  • 51.

    Tschudi DC, , Linder TE, & Fisch U: Conservative management of unilateral acoustic neuromas. Am J Otol 21:722728, 2000 Tschudi DC, Linder TE, Fisch U: Conservative management of unilateral acoustic neuromas. Am J Otol 21:722–728, 2000

    • Search Google Scholar
    • Export Citation
  • 52.

    Tsuzuki T, , Tsunoda S, & Sakaki T, et al: Tumor cell proliferation and apoptosis associated with the gamma knife effect. Stereotact Funct Neurosurg 66:3948, 1996 Tsuzuki T, Tsunoda S, Sakaki T, et al: Tumor cell proliferation and apoptosis associated with the gamma knife effect. Stereotact Funct Neurosurg 66:39–48, 1996

    • Search Google Scholar
    • Export Citation
  • 53.

    Unger F, , Walch C, & Papaefthymiou G, et al: Long term results of radiosurgery for vestibular schwannomas. Zentralbl Neurochir 63:5258, 2002 Unger F, Walch C, Papaefthymiou G, et al: Long term results of radiosurgery for vestibular schwannomas. Zentralbl Neurochir 63:52–58, 2002

    • Search Google Scholar
    • Export Citation
  • 54.

    Unger F, , Walch C, & Schrottner O, et al: Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir Suppl 84:7783, 2002 Unger F, Walch C, Schrottner O, et al: Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir Suppl 84:77–83, 2002

    • Search Google Scholar
    • Export Citation
  • 55.

    Walsh RM, , Bath AP, & Bance ML, et al: The natural history of untreated vestibular schwannomas. Is there a role for conservative management? Rev Laryngol Otol Rhinol 121:2126, 2000 Walsh RM, Bath AP, Bance ML, et al: The natural history of untreated vestibular schwannomas. Is there a role for conservative management? Rev Laryngol Otol Rhinol 121:21–26, 2000

    • Search Google Scholar
    • Export Citation
  • 56.

    Wowra B, , Horstmann GA, & Mack A, et al: Temporary swelling of vestibular schwannoma after radiosurgery, in 9th International Meeting of the Leksell Gamma Knife Society. Hong Kong, 1998 Wowra B, Horstmann GA, Mack A, et al: Temporary swelling of vestibular schwannoma after radiosurgery, in 9th International Meeting of the Leksell Gamma Knife Society. Hong Kong, 1998

    • Search Google Scholar
    • Export Citation
  • 57.

    Yamamoto M, , Hagiwara S, & Ide M, et al: Conservative management of acoustic neurinomas: prospective study of long-term changes in tumor volume and auditory function. Minim Invasive Neurosurg 41:8692, 1998 Yamamoto M, Hagiwara S, Ide M, et al: Conservative management of acoustic neurinomas: prospective study of long-term changes in tumor volume and auditory function. Minim Invasive Neurosurg 41:86–92, 1998

    • Search Google Scholar
    • Export Citation
  • 58.

    Yu CP, , Cheung JY, & Leung S, et al: Sequential volume mapping for confirmation of negative growth in vestibular schwannomas treated by gamma knife radiosurgery. J Neurosurg (Suppl 3) 93:8289, 2000 Yu CP, Cheung JY, Leung S, et al: Sequential volume mapping for confirmation of negative growth in vestibular schwannomas treated by gamma knife radiosurgery. J Neurosurg (Suppl 3) 93:82–89, 2000

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 400 84 5
Full Text Views 88 5 0
PDF Downloads 102 3 0
EPUB Downloads 0 0 0