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Wang SSY, Horstmann G, van Eck A, Tatagiba M, Naros G. Likelihood-of-harm/help of microsurgery compared to radiosurgery in large vestibular schwannoma. J Neurooncol 2024; 169:299-308. [PMID: 38951458 PMCID: PMC11341602 DOI: 10.1007/s11060-024-04732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE It has been shown that in large vestibular schwannomas (VS), radiosurgery (SRS) is inferior with respect to tumor control compared to microsurgical resection (SURGERY). However, SURGERY poses a significantly higher risk of facial-function deterioration (FFD). The aim of this study was to illustrate the effectiveness in terms of number-needed-to-treat/operate (NNO), number-needed-to-harm (NNH), and likelihood-of-harm/help (LHH) by comparing both treatment modalities in large VS. METHODS This was a retrospective, dual-center cohort study. Tumor size was classified by Hannover Classification. Absolute risk reduction and risk increase were used to derive additional estimates of treatment effectiveness, namely NNO and NNH. LHH was then calculated by a quotient of NNH/NNO to illustrate the risk-benefit-ratio of SURGERY. RESULTS Four hundred and forty-nine patients treated met the inclusion criteria. The incidence of tumor recurrence was significantly higher in SRS (14%), compared to SURGERY (3%) resulting in ARR of 11% and NNO of 10. At the same time, SURGERY was related to a significant risk of FFD resulting in an NNH of 12. Overall, the LHH calculated at 1.20 was favored SURGERY, especially in patients under the age of 40 years (LHH = 2.40), cystic VS (LHH = 4.33), and Hannover T3a (LHH = 1.83) and T3b (LHH = 1.80). CONCLUSIONS Due to a poorer response of large VS to SRS, SURGERY is superior with respect to tumor control. One tumor recurrence can be prevented, when 10 patients are treated by SURGERY instead of SRS. Thus, LHH portrays the benefit of SURGERY in large VS even when taking raised FFD into account.
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Affiliation(s)
- Sophie Shih-Yüng Wang
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany.
| | | | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
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Santhumayor BA, Mashiach E, Meng Y, Rotman L, Golub D, Bernstein K, Vasconcellos FDN, Silverman JS, Harter DH, Golfinos JG, Kondziolka D. Predictors of Hydrocephalus Risk After Stereotactic Radiosurgery for Vestibular Schwannomas: Utility of the Evans Index. Neurosurgery 2024:00006123-990000000-01310. [PMID: 39133020 DOI: 10.1227/neu.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hydrocephalus after Gamma Knife® stereotactic radiosurgery (SRS) for vestibular schwannomas is a rare but manageable occurrence. Most series report post-SRS communicating hydrocephalus in about 1% of patients, thought to be related to a release of proteinaceous substances into the cerebrospinal fluid. While larger tumor size and older patient age have been associated with post-SRS hydrocephalus, the influence of baseline ventricular anatomy on hydrocephalus risk remains poorly defined. METHODS A single-institution retrospective cohort study examining patients who developed symptomatic communicating hydrocephalus after undergoing Gamma Knife® SRS for unilateral vestibular schwannomas from 2011 to 2021 was performed. Patients with prior hydrocephalus and cerebrospinal fluid diversion or prior surgical resection were excluded. Baseline tumor volume, third ventricle width, and Evans Index (EI)-maximum width of the frontal horns of the lateral ventricles/maximum internal diameter of the skull-were measured on axial postcontrast T1-weighted magnetic resonance imaging. RESULTS A total of 378 patients met the inclusion criteria; 14 patients (3.7%) developed symptomatic communicating hydrocephalus and 10 patients (2.6%) underwent shunt placement and 4 patients (1.1%) were observed with milder symptoms. The median age of patients who developed hydrocephalus was 69 years (IQR, 67-72) and for patients younger than age 65 years, the risk was 1%. For tumor volumes <1 cm3, the risk of requiring shunting was 1.2%. The odds of developing symptomatic hydrocephalus were 5.0 and 7.7 times higher in association with a baseline EI > 0.28 (P = .024) and tumor volume >3 cm3 (P = .007), respectively, in multivariate analysis. Fourth ventricle distortion on pre-SRS imaging was significantly associated with hydrocephalus incidence (P < .001). CONCLUSION Patients with vestibular schwannoma with higher baseline EI, larger tumor volumes, and fourth ventricle deformation are at increased odds of developing post-SRS hydrocephalus. These patients should be counseled regarding risk of hydrocephalus and carefully monitored after SRS.
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Affiliation(s)
- Brandon A Santhumayor
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Elad Mashiach
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Ying Meng
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Lauren Rotman
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Danielle Golub
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Kenneth Bernstein
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | | | - Joshua S Silverman
- Department of Radiation Oncology, New York University Langone Health, New York, New York, USA
| | - David H Harter
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
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3
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De Leo AN, Shah A, Li J, Morris CG, Bova FJ, Friedman WA, Amdur RJ. Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression. Am J Clin Oncol 2024; 47:110-114. [PMID: 37981700 DOI: 10.1097/coc.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS. METHODS We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity. RESULTS Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%. CONCLUSION Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.
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Affiliation(s)
| | | | | | | | - Frank J Bova
- Neurosurgery, University of Florida College of Medicine, Gainesville, FL
| | - William A Friedman
- Neurosurgery, University of Florida College of Medicine, Gainesville, FL
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4
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Szymoniuk M, Kochański M, Wilk K, Miazga D, Kanonik O, Dryla A, Kamieniak P. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2024; 166:101. [PMID: 38393397 DOI: 10.1007/s00701-024-05995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or after subtotal resection. However, the optimal treatment for Koos-IV VS remains unclear. Therefore, our study aimed to evaluate the effectiveness of SRS as a primary treatment for large VS classified as Koos-IV. METHODS A systematic search was performed on December 28th, 2022, based on PubMed, Web of Science, and Scopus according to the PRISMA statement. The review was updated on September 7th, 2023. The risk of bias was assessed using the NIH Quality Assessment Tool. The R software (ver. 4.3.2) was used for all quantitative analyses and preparation of the forest plots. Publication bias and sensitivity analysis were performed to evaluate the reliability of the obtained results. RESULTS Among 2941 screened records, ten studies (1398 patients) have been included in quantitative synthesis. The overall tumor control rate was 90.7% (95%CI 86.3-94.4). Kaplan-Meier estimates of tumor control at 2, 6, and 10 years were 96.0% (95% CI 92.9-97.6%), 88.8% (95% CI 86.9-89.8%), and 84.5% (95% CI, 81.2-85.8%), respectively. The overall hearing preservation rate was 56.5% (95%CI 37-75.1). Kaplan-Meier estimates of hearing preservation rate at 2, 6, and 10 years were 77.1% (95% CI 67.9-82.5%), 53.5% (95% CI 44.2-58.5%), and 38.1% (95% CI 23.4-40.7%), respectively. The overall facial nerve preservation rate was 100% (95%CI 99.9-100.0). The overall trigeminal neuropathy rate reached 5.7% (95%CI 2.9-9.2). The overall rate of new-onset hydrocephalus was 5.6% (95%CI 3-9). The overall rates of worsening or new-onset tinnitus and vertigo were 6.8% (95%CI 4.2-10.0) and 9.1% (95%CI 2.1-19.6) respectively. No publication bias was detected according to the used methods. CONCLUSIONS Our systematic review and meta-analysis demonstrated a high overall tumor control rate, excellent facial nerve preservation, and low incidence of new-onset or worsened tinnitus and vertigo. However, several drawbacks associated with SRS should be noted, such as the presence of post-SRS hydrocephalus risk, mediocre long-term hearing preservation, and the lack of immediate tumor decompression. Nevertheless, the use of SRS may be beneficial in appropriately selected cases of Koos-IV VS. Moreover, further prospective studies directly comparing SRS with surgery are necessary to determine the optimal treatment for large VS and verify our results on a higher level of evidence. Registration and protocol: CRD42023389856.
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Affiliation(s)
- Michał Szymoniuk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Marek Kochański
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Karolina Wilk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Dominika Miazga
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Oliwia Kanonik
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Aleksandra Dryla
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
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Schouten SM, Cornelissen S, Langenhuizen PPHJ, Jansen TTG, Mulder JJS, Derks J, Verheul JB, Kunst HPM. Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas: A longitudinal volumetric study. Neurooncol Adv 2024; 6:vdad144. [PMID: 38187870 PMCID: PMC10771273 DOI: 10.1093/noajnl/vdad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth. Methods Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of ≥10%. Results Among 215 tumors with a median size (IQR) of 2.7 cm3 (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; P-value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; P < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; P = .01) at diagnosis were significantly associated with an increased likelihood of growth. Conclusions Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.
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Affiliation(s)
- Sammy M Schouten
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Stefan Cornelissen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick P H J Langenhuizen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Thijs T G Jansen
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jef J S Mulder
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jolanda Derks
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jeroen B Verheul
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
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6
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Alekseev IM, Ovchinnikov VA, Chupalenkov SM, Zuev AA. [Our approach to the treatment of vestibular schwannomas with arachnoid dissection of the facial nerve]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:38-49. [PMID: 39169580 DOI: 10.17116/neiro20248804138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Preserving the function of the facial nerve is extremely important in surgery for vestibular schwannomas. Two methods of arachnoid dissection are described for resection of vestibular schwannoma via retrosigmoid approach (from the brain stem and internal auditory canal). OBJECTIVE To evaluate the results of arachnoid dissection of the facial nerve from internal auditory canal when resecting the vestibular schwannoma. MATERIAL AND METHODS We analyzed 61 patients with vestibular schwannomas. Patients were divided into 2 groups depending on surgical technique. We estimated facial nerve function before and after surgery, preoperative dimension of vestibular schwannoma and extent of resection. The influence of various factors on extent of resection and postoperative facial nerve function was studied. RESULTS Vestibular schwannoma resection from the brain stem was performed in 30 patients, arachnoid dissection - in 31 patients. There was no significant between-group difference. Gross total resection was performed in 78.7% of cases. Both techniques demonstrated similar results regarding extent of resection. Arachnoid dissection showed the advantage regarding facial nerve function immediately after surgery (p=0.012) and 6 months later (p<0.001). Normal facial nerve function in 6 months after arachnoid dissection was observed in 80.7% of patients. Preoperative dimension of tumor influenced facial nerve function in addition to technique of resection (p=0.001). CONCLUSION We identified the factors influencing facial nerve function after resection of vestibular schwannoma. Surgical technique was the most significant factor. These data expand and popularize arachnoid dissection in surgery of vestibular schwannomas.
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Affiliation(s)
- I M Alekseev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | | | | | - A A Zuev
- Pirogov National Medical Surgical Center, Moscow, Russia
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7
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Abstract
Stereotactic radiosurgery (SRS) is a valid option for most patients undergoing treatment of small- and medium-sized vestibular schwannoma. Predictors of hearing preservation are the same for observation or surgery: when pretreatment hearing is normal, the tumor is smaller, and when a cerebrospinal fluid fundal cap exists. Hearing outcomes are poor when hearing loss exists pre-treatment. Rates of facial and trigeminal neuropathy are higher post-treatment after fractionated plans than single-fraction SRS. Subtotal resection and adjuvant radiation appears to offer patients with large tumors optimal outcomes for hearing, tumor control, and cranial nerve function versus gross total resection.
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8
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Chang HC, You WC, Shen CC, Chen YJ, Sun MH, Sheu ML, Pan LY, Sheehan J, Su KC, Pan HC. Using the deformity index of vital structures to predict outcome of patients with large vestibular schwannomas after Gamma Knife radiosurgery. J Neurooncol 2023; 162:179-189. [PMID: 36894719 DOI: 10.1007/s11060-023-04280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Microsurgery is the mainstay of treatment for large vestibular schwannomas (VS), but the benefits of radiosurgery remain incompletely defined. Here, we aim to use automated volumetric analysis software to quantify the degree of brain stem deformity to predict long-term outcomes of patients with large VS following GKRS. METHODS Between 2003 and 2020, 39 patients with large VS (volume > 8 cc) undergoing GKRS with a margin dose of 10-12 Gy were analyzed. The reconstruction 3D MRI was used to evaluate the extent of deformity for predicting the long-term outcome of patients. RESULTS Their mean tumor volume was 13.7 ± 6.3 cc, and their mean follow-up after GKRS was 86.7 ± 65.3 months. Favorable clinical outcome was observed in 26 (66.7%) patients, while 13 (33.3%) patients had treatment failure. Patients with small tumor volumes, low vital structure deformity indice [(TV/(BSV + CerV) and (TV + EV)/(BSV + CerV)], and long distance of tumor to the central line were more likely to have favorable clinical outcome after GKRS. Significant prognostic value was with tumor shrinkage ratio (< 50%) were CV, CV/TV, TV/CerV, (TV + EV)/(BSV + CerV), and the distance of tumor to the central line. In cox regression, favorable clinical outcome was correlated with the Charlson comorbidity index and cochlear dosage (both p < 0.05). In multivariant analysis, tumor regression was highly correlated with the CV/TV ratio (p < 0.001). CONCLUSIONS The brainstem deformity ratio is likely a useful index to assess the clinical and tumor regression outcomes. Clinical outcomes are multifactorial and the tumor regression was highly correlated with the ratio of cystic components.
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Affiliation(s)
- Hao-Chun Chang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Weir Chiang You
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying Ju Chen
- PhD program in Health and Social Welfare for Indigenous Peoples, Providence University, Taichung, Taiwan
| | - Ming-His Sun
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meei-Ling Sheu
- Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan
| | - Liang-Yi Pan
- Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4 Taichung, 40705, Taichung, Taiwan ROC
| | - Hung-Chuan Pan
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4 Taichung, 40705, Taichung, Taiwan ROC. .,Ph.D. program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
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9
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Dumot C, Pikis S, Mantziaris G, Xu Z, Dayawansa S, Anand RK, Nabeel AM, Sheehan D, Sheehan K, Reda WA, Tawadros SR, Karim KA, El-Shehaby AMN, Eldin RME, Peker S, Samanci Y, Kaisman-Elbaz T, Speckter H, Hernández W, Isidor J, Tripathi M, Madan R, Zacharia BE, Daggubati LC, Moreno NM, Álvarez RM, Langlois AM, Mathieu D, Deibert CP, Sudhakar VR, Cifarelli CP, Icaza DA, Cifarelli DT, Wei Z, Niranjan A, Barnett GH, Lunsford LD, Bowden GN, Sheehan JP. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study. Acta Neurochir (Wien) 2023; 165:211-220. [PMID: 36543963 DOI: 10.1007/s00701-022-05454-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old. METHOD This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up. RESULTS One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients. CONCLUSION SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.
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Affiliation(s)
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.,Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Sam Dayawansa
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Rithika Kormath Anand
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt
| | - Darrah Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Kimball Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt
| | - Reem M Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.,Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tehila Kaisman-Elbaz
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Herwin Speckter
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Wenceslao Hernández
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Julio Isidor
- Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic
| | - Manjul Tripathi
- Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | - Lekhaj C Daggubati
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | - Nuria Martínez Moreno
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA
| | | | - Anne-Marie Langlois
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | | | - Vivek R Sudhakar
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Christopher P Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Denisse Arteaga Icaza
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Daniel T Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Zhishuo Wei
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.
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