Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas

View More View Less
  • 1 Departments of Stereotactic and Functional Neurosurgery, Neurosurgery, and Ear, Nose, and Throat Surgery, Timone Hospital; and Department of Otoneurosurgery, Sainte Margerite Hospital, Marseille, France
Restricted access

Purchase Now

USD  $45.00

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

USD  $505.00

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

USD  $600.00
Print or Print + Online

Object. Microsurgical excision is an established treatment for vestibular schwannoma (VS). In 1992 the authors used a patient questionnaire to evaluate the functional outcome and quality of life in a series of 224 consecutive patients. In addition, starting with gamma knife surgery (GKS) in 1992, the authors decided to use the same methodology to evaluate prospectively the results of this modality to compare the two alternatives.

Methods. Among the 500 patients who were included prospectively, the authors only evaluated patients in whom GKS was the primary treatment for unilateral VS. Four years of follow up was available for the first 104 consecutive patients. Statistical analysis of the GKS and microsurgery populations has shown that only a comparison of Stage II and III (according to the Koos classification) was meaningful in terms of group size and preoperative risk factor distribution. Objective results and questionnaire answers from the first 97 consecutive patients were compared with the 110 patients in the microsurgery group who fulfilled the inclusion criteria.

Questionnaire answers indicated that 100% of patients who underwent GKS compared with 63% of patients who underwent microsurgery had no new facial motor disturbance. Forty-nine percent of patients who underwent GKS (17% in the microsurgery study) had no ocular symptoms, and 91% of patients treated with GKS (61% in the microsurgery study) had no functional deterioration after treatment. The mean hospitalization stay was 3 days after GKS and 23 days after microsurgery. All the patients who underwent GKS who had been employed, except one, had kept the same professional activity (56% in the microsurgery study). The mean time away from work was 7 days for GKS (130 days in the microsurgery study). Among patients whose preoperative hearing level was Class 1 according to the Gardner and Robertson scale, 70% preserved functional hearing after GKS (Class 1 or 2) compared with only 37.5% in the microsurgery group.

Conclusions. Functional side effects happen during the first 2 years after radiosurgery. Findings after 4 years of follow up indicated that GKS provided better functional outcomes than microsurgery in this patient series.

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

USD  $505.00

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

USD  $600.00

Contributor Notes

Address reprint requests to: Jean Régis, M.D., Service de Neurochirurgie Fonctionnelle et Stereotaxique, Hôpital d'adulte “la Timone”, Boulevard Jean Moulin, 13 385 Marseille Cedex 5, France. email: jregis@ap-hm.fr.
  • 1.

    Brackmann DE, , Hitselberger WE, & Beneke JE: Acoustic neuromas: middle fossa and translabyrinthine removal, in Rand RW (ed): Microneurosurgery, ed 3. St. Louis: Mosby, 1985, pp 311334 Brackmann DE, Hitselberger WE, Beneke JE: Acoustic neuromas: middle fossa and translabyrinthine removal, in Rand RW (ed): Microneurosurgery, ed 3. St. Louis: Mosby, 1985, pp 311–334

    • Search Google Scholar
    • Export Citation
  • 2.

    Ebersold MJ, , Harner SG, & Beatty CW, et al: Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg 76:901909, 1992 Ebersold MJ, Harner SG, Beatty CW, et al: Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg 76:901–909, 1992

    • Search Google Scholar
    • Export Citation
  • 3.

    Fischer G, , Fischer C, & Remond J: Hearing preservation in acoustic neurinoma surgery. J Neurosurg 76:910917, 1992 Fischer G, Fischer C, Remond J: Hearing preservation in acoustic neurinoma surgery. J Neurosurg 76:910–917, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    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
  • 5.

    Flickinger JC, , Lunsford LD, & Coffey RJ, et al: Radiosurgery of acoustic neurinomas. Cancer 67:345353, 1991 Flickinger JC, Lunsford LD, Coffey RJ, et al: Radiosurgery of acoustic neurinomas. Cancer 67:345–353, 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Gardner G, & Robertson JH: Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:5566, 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.

    Glasscock ME, , McKennan KX, & Levine SC: Acoustic neuroma surgery: the results of hearing conservation surgery. Laryngoscope 97:785789, 1987 Glasscock ME, McKennan KX, Levine SC: Acoustic neuroma surgery: the results of hearing conservation surgery. Laryngoscope 97:785–789, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    Glasscock ME III, , Hays JW, & Minor LB, et al: Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 78:864870, 1993 Glasscock ME III, Hays JW, Minor LB, et al: Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 78:864–870, 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Gormley WB, , Sekhar LN, & Wright DC, et al: Acoustic neuromas: results of current surgical management. Neurosurgery 41:5060, 1997 Gormley WB, Sekhar LN, Wright DC, et al: Acoustic neuromas: results of current surgical management. Neurosurgery 41:50–60, 1997

    • Search Google Scholar
    • Export Citation
  • 10.

    Hardy DG, , Macfarlane R, & Baguley D, et al: Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations. J Neurosurg 71:799804, 1989 Hardy DG, Macfarlane R, Baguley D, et al: Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations. J Neurosurg 71:799–804, 1989

    • Search Google Scholar
    • Export Citation
  • 11.

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146147, 1985 House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147, 1985

    • Search Google Scholar
    • Export Citation
  • 12.

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

    • Search Google Scholar
    • Export Citation
  • 13.

    Koos WT, , Day JD, & Matula C, et al: Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506512, 1998 Koos WT, Day JD, Matula C, et al: Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512, 1998

    • Search Google Scholar
    • Export Citation
  • 14.

    Koos WT, , Spetzler RF, & Böck FW, et al: Microsurgery of cerebellopontine angle tumors, in Koos WT, , Böck FW, & Spetzler RF (eds): Clinical Microneurosurgery. Stuttgart, Thieme, 1976, pp 91112 Koos WT, Spetzler RF, Böck FW, et al: Microsurgery of cerebellopontine angle tumors, in Koos WT, Böck FW, Spetzler RF (eds): Clinical Microneurosurgery. Stuttgart, Thieme, 1976, pp 91–112

    • Search Google Scholar
    • Export Citation
  • 15.

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

    • Search Google Scholar
    • Export Citation
  • 16.

    Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316319, 1951 Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316–319, 1951

    • Search Google Scholar
    • Export Citation
  • 17.

    Linskey ME, , Lunsford LD, & Flickinger JC, et al: Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin N Am 3:191205, 1992 Linskey ME, Lunsford LD, Flickinger JC, et al: Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin N Am 3:191–205, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Lunsford LD, , Kondziolka D, & Flickinger JC: Radiosurgery as an alternative to microsurgery of acoustic tumors. Clin Neurosurg 38:619634, 1992 Lunsford LD, Kondziolka D, Flickinger JC: Radiosurgery as an alternative to microsurgery of acoustic tumors. Clin Neurosurg 38:619–634, 1992

    • Search Google Scholar
    • Export Citation
  • 19.

    Marquet JFE, , Forton GEJ, & Offeciers FE, et al: The solitary schwannoma of the eighth cranial nerve. An immunohistochemical study of the cochlear nerve-tumor interface. Arch Otolaryngol Head Neck Surg 116:10231025, 1990 Marquet JFE, Forton GEJ, Offeciers FE, et al: The solitary schwannoma of the eighth cranial nerve. An immunohistochemical study of the cochlear nerve-tumor interface. Arch Otolaryngol Head Neck Surg 116:1023–1025, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Matthies C, & Samii M: Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 40:110, 1997 Matthies C, Samii M: Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 40:1–10, 1997

    • Search Google Scholar
    • Export Citation
  • 21.

    Matthies C, & Samii M: Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for intraoperative monitoring of auditory function in 200 cases. Neurosurgery 40:459468, 1997 Matthies C, Samii M: Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for intraoperative monitoring of auditory function in 200 cases. Neurosurgery 40:459–468, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Matthies C, , Samii M, & Krebs S: Management of vestibular schwannomas (acoustic neuromas): radiological features in 202 cases—their value for diagnosis and their predictive importance. Neurosurgery 40:469482, 1997 Matthies C, Samii M, Krebs S: Management of vestibular schwannomas (acoustic neuromas): radiological features in 202 cases—their value for diagnosis and their predictive importance. Neurosurgery 40:469–482, 1997

    • Search Google Scholar
    • Export Citation
  • 23.

    Moffat DA, & Hardy DG: Near-total, subtotal or partial removal of acoustic neuromas, in Tos M, & Thomsen J (eds): Acoustic Neuroma: Proceedings of the First International Conference on Acoustic Neuroma. Copenhagen: Kugler, 1992, pp 691695 Moffat DA, Hardy DG: Near-total, subtotal or partial removal of acoustic neuromas, in Tos M, Thomsen J (eds): Acoustic Neuroma: Proceedings of the First International Conference on Acoustic Neuroma. Copenhagen: Kugler, 1992, pp 691–695

    • Search Google Scholar
    • Export Citation
  • 24.

    Nadol JB Jr, , Levine R, & Ojemann RG, et al: Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle. Laryngoscope 97:12871294, 1987 Nadol JB Jr, Levine R, Ojemann RG, et al: Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle. Laryngoscope 97:1287–1294, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Neely JG: Is it possible to totally resect an acoustic tumor and conserve hearing? Otolaryngol Head Neck Surg 92:162167, 1984 Neely JG: Is it possible to totally resect an acoustic tumor and conserve hearing? Otolaryngol Head Neck Surg 92:162–167, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Norén G: Gamma knife radiosurgery for acoustic neurinomas, in Gildenberg PL, & Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1996, Vol 1, pp 835844 Norén G: Gamma knife radiosurgery for acoustic neurinomas, in Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1996, Vol 1, pp 835–844

    • Search Google Scholar
    • Export Citation
  • 27.

    Norén G, , Greitz D, & Hirsch A, et al: Gamma knife radiosurgery in acoustic neurinoma, in Steiner L (ed): Radiosurgery: Baseline and Trends. New York: Raven Press, 1992, pp 141148 Norén G, Greitz D, Hirsch A, et al: Gamma knife radiosurgery in acoustic neurinoma, in Steiner L (ed): Radiosurgery: Baseline and Trends. New York: Raven Press, 1992, pp 141–148

    • Search Google Scholar
    • Export Citation
  • 28.

    Ojemann RG: Management of acoustic neuromas (vestibular schwannomas). Clin Neurosurg 40:498535, 1993 Ojemann RG: Management of acoustic neuromas (vestibular schwannomas). Clin Neurosurg 40:498–535, 1993

    • Search Google Scholar
    • Export Citation
  • 29.

    Palva T, , Troupp H, & Jauhiainen T: Hearing preservation in acoustic neurinoma surgery. Acta Otolaryngol 99:17, 1985 Palva T, Troupp H, Jauhiainen T: Hearing preservation in acoustic neurinoma surgery. Acta Otolaryngol 99:1–7, 1985

    • Search Google Scholar
    • Export Citation
  • 30.

    Pellet W: Abord trans-labyrinthique des schwannomes vestibulaires. Indications respectives à la chirurgie et à la radio-chirurgie, in Société de Neurochirurgie de Langue Française. Société Française de Neuroradiologie. Paris: Bayer Pharma, 1994 Pellet W: Abord trans-labyrinthique des schwannomes vestibulaires. Indications respectives à la chirurgie et à la radio-chirurgie, in Société de Neurochirurgie de Langue Française. Société Française de Neuroradiologie. Paris: Bayer Pharma, 1994

    • Search Google Scholar
    • Export Citation
  • 31.

    Pellet W: Stereotactic radiosurgery for acoustic neurinomas and petrous apex and cerebellopontine angle meningiomas. Crit Rev Neurosurg 1:331342, 1991 Pellet W: Stereotactic radiosurgery for acoustic neurinomas and petrous apex and cerebellopontine angle meningiomas. Crit Rev Neurosurg 1:331–342, 1991

    • Search Google Scholar
    • Export Citation
  • 32.

    Pellet W, , Emram B, & Cannoni M, et al: Les resultats fonctionnels de la chirurgie des neurinomes de l'acoustique unilateraux. Neurochirurgie 39:2441, 1993 Pellet W, Emram B, Cannoni M, et al: Les resultats fonctionnels de la chirurgie des neurinomes de l'acoustique unilateraux. Neurochirurgie 39:24–41, 1993

    • Search Google Scholar
    • Export Citation
  • 33.

    Pollock BE, , Lunsford LD, & Noren G: Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 43:475483, 1998 Pollock BE, Lunsford LD, Noren G: Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 43:475–483, 1998

    • Search Google Scholar
    • Export Citation
  • 34.

    Post KD, , Eisenberg MB, & Catalano PJ: Hearing preservation in vestibular schwannoma surgery: what factors influence outcome? J Neurosurg 83:191196, 1995 Post KD, Eisenberg MB, Catalano PJ: Hearing preservation in vestibular schwannoma surgery: what factors influence outcome? J Neurosurg 83:191–196, 1995

    • Search Google Scholar
    • Export Citation
  • 35.

    Regis J, & Pellet W: Radiochirurgie ou microchirurgie des Schwannomes vestibulaires. Cancer Radiother 2:191201, 1998 Regis J, Pellet W: Radiochirurgie ou microchirurgie des Schwannomes vestibulaires. Cancer Radiother 2:191–201, 1998

    • Search Google Scholar
    • Export Citation
  • 36.

    Rosenberg RA, , Cohen NL, & Ransohoff J: Long-term hearing preservation after acoustic neuroma surgery. Otolaryngol Head Neck Surg 97:270274, 1987 Rosenberg RA, Cohen NL, Ransohoff J: Long-term hearing preservation after acoustic neuroma surgery. Otolaryngol Head Neck Surg 97:270–274, 1987

    • Search Google Scholar
    • Export Citation
  • 37.

    Rosenberg SI, , Silverstein H, & Gordon MA, et al: A comparison of growth rates of acoustic neuromas: nonsurgical patients versus subtotal resection. Otolaryngol Head Neck Surg 109:482487, 1993 Rosenberg SI, Silverstein H, Gordon MA, et al: A comparison of growth rates of acoustic neuromas: nonsurgical patients versus subtotal resection. Otolaryngol Head Neck Surg 109:482–487, 1993

    • Search Google Scholar
    • Export Citation
  • 38.

    Samii M: Hearing preservation in bilateral acoustic neurinomas. Br J Neurosurg 9:413424, 1995 Samii M: Hearing preservation in bilateral acoustic neurinomas. Br J Neurosurg 9:413–424, 1995

    • Search Google Scholar
    • Export Citation
  • 39.

    Samii M, & Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40:248262, 1997 Samii M, Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40:248–262, 1997

    • Search Google Scholar
    • Export Citation
  • 40.

    Samii M, & Mathies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:1123, 1997 Samii M, Mathies 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
  • 41.

    Schessel DA, , Nedzelski JM, & Kassel EE, et al: Recurrence rate of acoustic neuroma in hearing preservation surgery. Am J Otol 13:233235, 1992 Schessel DA, Nedzelski JM, Kassel EE, et al: Recurrence rate of acoustic neuroma in hearing preservation surgery. Am J Otol 13:233–235, 1992

    • Search Google Scholar
    • Export Citation
  • 42.

    Silverstein H, , Rosenberg SI, & Flanzer JM, et al: An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms. Otolaryngol Head Neck Surg 108:110, 1993 Silverstein H, Rosenberg SI, Flanzer JM, et al: An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms. Otolaryngol Head Neck Surg 108:1–10, 1993

    • Search Google Scholar
    • Export Citation
  • 43.

    Storb R, , Prentice RL, & Thomas ED: Marrow transplantation for treatment of aplastic anemia. An analysis of factors associated with graft resection. N Engl J Med 296:6166, 1977 Storb R, Prentice RL, Thomas ED: Marrow transplantation for treatment of aplastic anemia. An analysis of factors associated with graft resection. N Engl J Med 296:61–66, 1977

    • Search Google Scholar
    • Export Citation
  • 44.

    Thomassin JM, , Epron JP, & Regis J, et al: Preservation of hearing in acoustic neuromas treated by gamma knife surgery. Stereotact Funct Neurosurg 70 (Suppl 1):7479, 1998 Thomassin JM, Epron JP, Regis J, et al: Preservation of hearing in acoustic neuromas treated by gamma knife surgery. Stereotact Funct Neurosurg 70 (Suppl 1):74–79, 1998

    • Search Google Scholar
    • Export Citation
  • 45.

    Thomassin JM, , Pellet W, & Epron JP, et al: Les récidives des neurinomes de l'acoustique apres éxérèse chirurgicale. Ann Otolaryngol Chir Cervicofac 118:310, 2001 Thomassin JM, Pellet W, Epron JP, et al: Les récidives des neurinomes de l'acoustique apres éxérèse chirurgicale. Ann Otolaryngol Chir Cervicofac 118:3–10, 2001

    • Search Google Scholar
    • Export Citation
  • 46.

    Thomsen J, & Tos M: Management of acoustic neuromas. Ann Otolaryngol Chir Cervicofac 110:179191, 1993 Thomsen J, Tos M: Management of acoustic neuromas. Ann Otolaryngol Chir Cervicofac 110:179–191, 1993

    • Search Google Scholar
    • Export Citation
  • 47.

    Weiss NS, , Szekely DR, & English DR, et al: Endometrial cancer in relation to patterns of menopausal estrogen use. JAMA 242:261264, 1979 Weiss NS, Szekely DR, English DR, et al: Endometrial cancer in relation to patterns of menopausal estrogen use. JAMA 242:261–264, 1979

    • Search Google Scholar
    • Export Citation
  • 48.

    Whittaker CK, & Luetje CM: Vestibular schwannomas. J Neurosurg 76:897900, 1992 Whittaker CK, Luetje CM: Vestibular schwannomas. J Neurosurg 76:897–900, 1992

    • Search Google Scholar
    • Export Citation
  • 49.

    Wiegand DA, & Fickel V: Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 99:179187, 1989 Wiegand DA, Fickel V: Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 99:179–187, 1989

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 470 203 12
Full Text Views 287 40 6
PDF Downloads 123 37 6
EPUB Downloads 0 0 0