Indian Journal of Neurosurgery 2014; 03(03): 144-149
DOI: 10.4103/2277-9167.146828
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Radiosurgery for vestibular schwannomas

Sumit Sinha
,
A.K. Mahapatra
1   All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

Abstract

Vestibular schwannomas (VS) are benign tumours arising from the 8th cranial nerve. There are various treatment options for these tumours, which depend upon the tumour size and patient age. However, the surgical treatment has been the conventional method of management of these tumours, since they are frequently detected when quite large in size, especially in our country. Gamma knife radiosurgery (GKRS) is frequently reserved for young patients with small and medium-sized VS (<3 cm) and few symptoms. The tumour control dose is the most important consideration in GKRS, with higher doses having a risk for cranial nerve palsies, whereas lower doses leading to non-treatment of the tumour. The accepted tumour control dose ranges from 12 to 16 Gy among the various series with the tumour control rates of from 87% to 98% considered generally acceptable. The preservation of hearing is an issue worthwhile to be taken into account in GKRS and various series reporting this to range from 40% to 80%. The comparison between microsurgery and GKRS is still debatable because of different indications for both forms of therapies. Microsurgery is chosen for large tumours and GKRS for relatively smaller tumours.

 
  • References

  • 1 Propp JM, McCarthy BJ, Davis FG, Preston-Martin S. Descriptive epidemiology of vestibular schwannomas. Neuro Oncol 2006; 8: 1-11
  • 2 Paek SH, Chung HT, Jeong SS, Park CK, Kim CY, Kim JE. et al Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 2005; 104: 580-590
  • 3 Paeng SH, Kim MS, Sim HB. Gamma-knife radiosurgery for vestibular schwannoma. J Korean Neurosurg Soc 2001; 30: 1308-1313
  • 4 Pollack AG, Marymont MH, Kalapurakal JA, Kepka A, Sathiaseelan V, Chandler JP. Acute neurological complications following gamma knife surgery for vestibular schwannoma. Case report. J Neurosurg 2005; 103: 546-551
  • 5 Leksell L. Stereotactic radiosurgery. J Neurol Neurosurg Psychiatry 1983; 46: 797-803
  • 6 Leksell L. A note on the treatment of acoustic tumors. Acta Chir Scand 1969; 137: 763-765
  • 7 Leksell L. A note on the treatment of acoustic tumours. Acta Chir Scand 1971; 137: 763-765
  • 8 Norén G. Gamma knife radiosurgery of acoustic neurinomas. A historic perspective. Neurochirurgie 2004; 50: 253-256
  • 9 Flickinger JC, Kondziolka D, Lunsford LD. Dose and diameter relationships for facial, trigeminal and acoustic neuropathies following acoustic neuroma radiosurgery. Radiother Oncol 1996; 41: 215-219
  • 10 Flickinger JC, Kondziolka D, Niranjan A, Maitz A, Voynov G, Lunsford LD. Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2004; 60: 225-230
  • 11 Meeks SL, Buatti JM, Foote KD, Friedman WA, Bova FJ. Calculation of cranial nerve complication probability for acoustic neuroma radiosurgery. Int J Radiat Oncol Biol Phys 2000; 47: 597-602
  • 12 Mitsuoka H, Arai H, Tsunoda A, Okuda O, Sato K, Makita J. Microanatomy of the cerebellopontine angle and internal auditory canal: Study with new magnetic resonance imaging technique using three-dimensional fast spin echo. Neurosurgery 1999; 44: 561-566
  • 13 Novotny Jr J, Vymazal J, Novotny J, Tlachacova D, Schmitt M, Chuda P. et al Does new magnetic resonance imaging technology provide better geometrical accuracy during stereotactic imaging?. J Neurosurg 2005; 102 Suppl 8-13
  • 14 Lim YJ, Lee CY, Koh JS, Kim TS, Kim GK, Rhee BA. Seizure control of Gamma Knife radiosurgery for non-hemorrhagic arteriovenous malformations. Acta Neurochir Suppl 2006; 99: 97-101
  • 15 Park SH, Lim YJ, Leem W, Rhee BA, Kim GK, Kim TS. Comparative study of angiography and magnetic resonance image in verifying obliteration of arteriovenous malformation after gamma knife radiosurgery. J Korean Neurosurg Soc 2002; 32: 407-412
  • 16 Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD. Results of acoustic neuroma radiosurgery: An analysis of 5 years’ experience using current methods. J Neurosurg 2001; 94: 1-6
  • 17 Forster DM, Kemeny AA, Pathak A, Walton L. Radiosurgery: A minimally interventional alternative to microsurgery in the management of acoustic neuroma. Br J Neurosurg 1996; 10: 169-174
  • 18 Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC. Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 1998; 339: 1426-1433
  • 19 Linskey ME, Lunsford LD, Flickinger JC. Radiosurgery for acoustic neurinomas: Early experience. Neurosurgery 1990; 26: 736-744
  • 20 Kamerer DB, Lunsford LD, Møller M. Gamma knife: An alternative treatment for acoustic neurinomas. Ann Otol Rhinol Laryngol 1988; 97: 631-635
  • 21 Norén G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: Further experiences. Neurosurgery 1983; 13: 12-22
  • 22 Norén G, Greitz D, Hirsch A, Lax I. Gamma knife surgery in acoustic tumours. Acta Neurochir Suppl (Wien) 1993; 58: 104-107
  • 23 Prasad D, Steiner M, Steiner L. Gamma surgery for vestibular schwannoma. J Neurosurg 2000; 92: 745-759
  • 24 Linskey ME, Lunsford LD, Flickinger JC. Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR Am J Neuroradiol 1991; 12: 1165-1175
  • 25 Chung WY, Liu KD, Shiau CY, Wu HM, Wang LW, Guo WY. et al Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 2005; 102 Suppl 87-96
  • 26 Levegrün S, Hof H, Essig M, Schlegel W, Debus J. Radiation-induced changes of brain tissue after radiosurgery in patients with arteriovenous malformations: Correlation with dose distribution parameters. Int J Radiat Oncol Biol Phys 2004; 59: 796-808
  • 27 Weil RS, Cohen JM, Portarena I, Brada M. Optimal dose of stereotactic radiosurgery for acoustic neuromas: A systematic review. Br J Neurosurg 2006; 20: 195-202
  • 28 Ogunrinde OK, Lunsford DL, Kondziolka DS, Bissonette DJ, Flickinger JC. Cranial nerve preservation after stereotactic radiosurgery of intracanalicular acoustic tumors. Stereotact Funct Neurosurg 1995; 64 (Suppl. 01) 87-97
  • 29 Backlund EO. Stereotactic radiosurgery in intracranial tumors and vascular malformations. Adv Tech Stand Neurosurg 1979; 6: 3-37
  • 30 Selesnick SH, Jackler RK, Pitts LW. The changing clinical presentation of acoustic tumors in the MRI era. Laryngoscope 1993; 103: 431-436
  • 31 Seo Y, Fukuoka S, Nakagawara J, Takanashi M, Takahashi S, Suematsu K. 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 1996; 66 (Suppl. 01) 93-102
  • 32 Delsanti C, Régis J. Cystic vestibular schwannomas. Neurochirurgie 2004; 50: 401-406
  • 33 Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J. Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up. J Neurosurg 2005; 102: 10-16
  • 34 Lee F, Linthicum Jr F, Hung G. Proliferation potential in recurrent acoustic schwannoma following gamma knife radiosurgery versus microsurgery. Laryngoscope 2002; 112: 948-950
  • 35 Norén G. Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 1998; 70 (Suppl. 01) 65-73
  • 36 Subach BR, Kondziolka D, Lunsford LD, Bissonette DJ, Flickinger JC, Maitz AH. Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis type 2. J Neurosurg 1999; 90: 815-822
  • 37 Betchen SA, Walsh J, Post KD. Long-term hearing preservation after surgery for vestibular schwannoma. J Neurosurg 2005; 102: 6-9
  • 38 Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J. Stereotactic radiosurgery for vestibular schwannomas: Analysis of 317 patients followed more than 5 years. Neurosurgery 2005; 57: 257-265
  • 39 Foote KD, Friedman WA, Buatti JM, Meeks SL, Bova FJ, Kubilis PS. Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 2001; 95: 440-449
  • 40 Linskey ME, Lunsford LD, Flickinger JC. Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors. Neurosurgery 1992; 31: 829-838
  • 41 Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D. Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 1999; 45: 753-762
  • 42 Vermeulen S, Young R, Posewitz A, Grimm P, Blasko J, Kohler E. et al Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: The Seattle Northwest gamma knife experience. Stereotact Funct Neurosurg 1998; 70 (Suppl. 01) 80-87
  • 43 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: Summary of experience in 829 cases. J Neurosurg 2005; 102 Suppl 195-199
  • 44 Régis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM. et al Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 2002; 97: 1091-1100
  • 45 Yamakami I, Uchino Y, Kobayashi E, Yamaura A. Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: A systematic review of outcome and risk of three therapeutic options. Neurol Res 2003; 25: 682-690
  • 46 Iwai Y, Yamanaka K, Shiotani M, Uyama T. Radiosurgery for acoustic neuromas: Results of low-dose treatment. Neurosurgery 2003; 53: 282-287
  • 47 Yu CP, Cheung JY, Leung S, Ho R. Sequential volume mapping for confirmation of negative growth in vestibular schwannomas treated by gamma knife radiosurgery. J Neurosurg 2000; 93 (Suppl. 03) 82-89
  • 48 Thomassin JM, Epron JP, Régis J, Delsanti C, Sarabian A, Peragut JC. et al Preservation of hearing in acoustic neuromas treated by gamma knife surgery. Stereotact Funct Neurosurg 1998; 70 (Suppl. 01) 74-79
  • 49 Sekiya T, Møller AR. Cochlear nerve injuries caused by cerebellopontine angle manipulations. An electrophysiological and morphological study in dogs. J Neurosurg 1987; 67: 244-249
  • 50 Cho JH, Paek SH, Chung HT, Jeong SS, Jung HW, Kim DG. Hearing outcome after gamma knife stereotactic radiosurgery in vestibular schwannoma patients with serviceable hearing. J Korean Neurosurg Soc 2006; 40: 336-341
  • 51 Schneider BF, Eberhard DA, Steiner LE. Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 1997; 87: 352-357
  • 52 Gabert K, Régis J, Delsanti C, Roche PH, Facon F, Tamura M. et al Preserving hearing function after Gamma Knife radiosurgery for unilateral vestibular schwannoma. Neurochirurgie 2004; 50: 350-357
  • 53 Roche PH, Ribeiro T, Soumare O, Robitail S, Pellet W, Régis J. Hydrocephalus and vestibular schwannomas treated by Gamma Knife radiosurgery. Neurochirurgie 2004; 50: 345-349
  • 54 Myrseth E, Møller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M. Schwannomas: Clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 2005; 56: 927-935
  • 55 Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF. et al Outcome analysis of acoustic neuroma management: A comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 1995; 36: 215-224
  • 56 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): Hearing function in 1000 tumor resections. Neurosurgery 1997; 40: 248-260
  • 57 Mathieu D, Kondziolka D, Flickinger JC, Niranjan A, Williamson R, Martin JJ. et al Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: An analysis of tumor control, complications and hearing preservation rates. Neurosurgery 2007; 60: 460-468
  • 58 Møller P, Myrseth E, Pedersen PH, Larsen JL, Krakenes J, Moen G. Acoustic neuroma - Treatment modalities. Surgery, gamma-knife or observation?. Acta Otolaryngol Suppl 2000; 543: 34-37
  • 59 Régis J, Delsanti C, Roche PH, Thomassin JM, Pellet W. Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature. Neurochirurgie 2004; 50: 301-311
  • 60 Pollock BE, Lunsford LD, Kondziolka D, Sekula R, Subach BR, Foote RL. et al Vestibular schwannoma management. Part II. Failed radiosurgery and the role of delayed microsurgery. J Neurosurg 1998; 89: 949-955
  • 61 Pendl G, Ganz JC, Kitz K, Eustacchio S. Acoustic neurinomas with macrocysts treated with Gamma Knife radiosurgery. Stereotact Funct Neurosurg 1996; 66 (Suppl. 01) 103-111