Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Translation of the questionnaire sent to the patients*

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    Bar graph showing hearing preservation evaluated by the patients. In each surgical group, the patients were asked if the hearing on the treated side is completely lost, decreased, stable, or improved. Numbers on the y axis represent the number of patients.

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    Upper: Graph showing hospital stay; the hospital stay is shorter after radiosurgery compared with microsurgery (p = 0.000001). The event is the exit from the hospital, and time is expressed in days. Lower: Graph showing the time course of the “return to work” parameter in each of the two groups. Among the GKS group all but one of the patients had returned to work (this patient has no functional complaint). Among the microsurgery group only 66% of the patients had a functional outcome compatible with their previous employment and were able to return to work. The mean period off work was 120 days after microsurgery and 7 days after radiosurgery (p = 0.00016). Numbers on the y axis represent percentages of patients remaining in the hospital (upper) and returning to work (lower).

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    Graph showing the increase of average tumor volume (y axis) over time. One can deduce from this graph a slow growth in lesion size over the 6 months post-GKS. It is interesting to observe a significant increase in the preoperative average volume. In the subgroup of patients who presented with a marked increase in tumor volume between the moment of diagnosis and the operation (35%), the central necrosis and postoperative growth were even more marked.

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