Leksell Top 25 - Vestibular Schwannoma

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Dheerendra Prasad, Melita Steiner and Ladislau Steiner

Object. The goal of this study was to assess the results of gamma surgery (GS) for vestibular schwannoma (VS) in 200 cases treated over the last 10 years and to review the role of this neurosurgical procedure in the management of VS.

Methods. Follow-up reviews ranging from 1 to 10 years were available in 153 of these patients. Follow-up images in these cases were analyzed using computer software that we developed to obtain volume measurements for the tumors, and the clinical condition of the patients was assessed using questionnaires.

Gamma surgery was the primary treatment modality in 96 cases and followed microsurgery in 57 cases. Tumors ranged in volume from 0.02 to 18.3 cm3. In the group in which GS was the primary treatment, a decrease in volume was observed in 78 cases (81%), no change in 12 (12%), and an increase in volume in six cases (6%). The decrease was more than 75% in seven cases. In the group treated following microsurgery, a decrease in volume was observed in 37 cases (65%), no change in 14 (25%), and an increase in volume in six (11%). The decrease was more than 75% in eight cases. Five patients experienced trigeminal dysfunction; in three cases this was transient and in the other two it was persistent, although there has been improvement. Three patients had facial paresis (in one case this was transient, lasting 6 weeks; in one case there was 80% recovery at 18 months posttreatment; and in one case surgery was performed after the onset of facial paresis for presumed increase in tumor size). Over a 6-year period, hearing deteriorated in 60% of the patients. Three patients showed an improvement in hearing. No hearing deterioration was observed during the first 2 years of follow-up review.

Conclusions. Gamma surgery should be used to treat postoperative residual tumors as well as tumors in patients with medical conditions that preclude surgery. Microsurgery should be performed whenever a surgeon is confident of extirpating the tumor with a risk—benefit ratio superior to that presented in this study.