Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases

Wen-Yuh Chung M.D. 1 , Kang-Du Liu M.D. 1 , Cheng-Ying Shiau M.D. 1 , Hsiu-Mei Wu M.D. 1 , Ling-Wei Wang M.D. 1 , Wan-Yuo Guo M.D., Ph.D. 1 , Donald Ming-Tak Ho M.D., F.R.C.P.(C), F.C.A.P. 1 , and David Hung-Chi Pan M.D. 1
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  • 1 Departments of Neurosurgery (Cancer Center), Radiology, and Pathology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
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Object. The authors conducted a study to determine the optimal radiation dose for vestibular schwannoma (VS) and to examine the histopathology in cases of treatment failure for better understanding of the effects of irradiation.

Methods. A retrospective study was performed of 195 patients with VS; there were 113 female and 82 male patients whose mean age was 51 years (range 11–82 years). Seventy-two patients (37%) had undergone partial or total excision of their tumor prior to gamma knife surgery (GKS). The mean tumor volume was 4.1 cm3 (range 0.04–23.1 cm3). Multiisocenter dose planning placed a prescription dose of 11 to 18.2 Gy on the 50 to 94% isodose located at the tumor margin. Clinical and magnetic resonance (MR) imaging follow-up evaluations were performed every 6 months.

A loss of central enhancement was demonstrated on MR imaging in 69.5% of the patients. At the latest MR imaging assessment decreased or stable tumor volume was demonstrated in 93.6% of the patients. During a median follow-up period of 31 months resection was avoided in 96.8% of cases. Uncontrolled tumor swelling was noted in five patients at 3.5, 17, 24, 33, and 62 months after GKS, respectively. Twelve of 20 patients retained serviceable hearing. Two patients experienced a temporary facial palsy. Two patients developed a new trigeminal neuralgia. There was no treatment-related death. Histopathological examination of specimens in three cases (one at 62 months after GKS) revealed a long-lasting radiation effect on vessels inside the tumor.

Conclusions. Radiosurgery had a long-term radiation effect on VSs for up to 5 years. A margin 12-Gy dose with homogeneous distribution is effective in preventing tumor progression, while posing no serious threat to normal cranial nerve function.

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Contributor Notes

Address reprint requests to: Wen-Yuh Chung, M.D., Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, Republic of China. email: wychung@vghtpe.gov.tw.
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