Whether Gamma Knife Radiosurgery Is Really Necessary for Treatment of Patients with Vestibular Schwannomas
The present study was directed at establishing the role of Gamma Knife radiosurgery (GKS) in the management of vestibular schwannomas (VSs), particularly those that are large. We analyzed a consecutive series of 222 tumors operated on by a single neurosur
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Abstract The present study was directed at establishing the role of Gamma Knife radiosurgery (GKS) in the management of vestibular schwannomas (VSs), particularly those that are large. We analyzed a consecutive series of 222 tumors operated on by a single neurosurgeon (T. Hori) at Tottori University (1981–1998) and Tokyo Women’s Medical University (1998–2011). The surgical strategy for sporadic unilateral VSs was typically total or nearly total tumor removal with facial nerve preservation, whereas in some cases of neurofibromatosis type 2 intentional subtotal resection was performed. In all, 15 patients (8.6 %) in the series underwent GKS before (4 cases), after (9 cases), or before and after (2 cases) tumor removal. Overall, 211 patients (95 %) were cured by microsurgery alone. Of note, six patients underwent primary radiosurgery but were operated later on for regrowth of the neoplasm, and in four of them near-total resection led to good long-term tumor control. GKS was required in only 5 % of cases for management of residual VS or, more frequently, its regrowth. Radiosurgery resulted in volume reduction in one-third of these tumors. In other cases it stabilized the lesion, preventing further progression. Thus, GKS is considered a reasonable management option for residual or regrowing small VSs to obtain maximum tumor growth control after initially attempting complete surgical removal.
T. Hori () Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan Moriyama Memorial Hospital, 7-12-7, Nishikasai, Edogawa-ku, Tokyo 134-0088, Japan e-mail: [email protected] T. Maruyama Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan
Keywords Endoscopy • Gamma Knife • Koos stage • Retrosigmoid transmeatal approach • Vestibular schwannoma
Introduction Many medical practitioners, including neurosurgeons, consider radiosurgery an option for treating patients with a vestibular schwannoma (VS). It is an effective alternative to open surgery. The technique might be helpful for improving tumor growth control after incomplete removal of large neoplasms and for small residual lesions [9, 10]. At present irradiation is frequently used for primary management of VSs of various sizes. Although its usefulness is advocated widely [4], the efficacy of stereotactic irradiation in such cases raises serious concerns. The present study focused on establishing the role of Gamma Knife radiosurgery (GKS) in the management of VS, particularly large ones by analyzing a consecutive series of such tumors operated on by a single surgeon (T. Hori).
Materials and Methods The series included 222 patients with a VS. The initial 48 patients were treated surgically at Tottori University (1981– 1998). None of these patients underwent GKS before or after tumor removal. The VS recurred in two of the patients in this group, and both underwent reoperation, which led to excellent long-term tumor control. Hence, the efficacy of radiosurgery in this cohort could not be
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