Preserving normal facial nerve function and improving hearing outcome in large vestibular schwannomas with a combined approach: planned subtotal resection followed by gamma knife radiosurgery

Autor: Luis Schiappacasse, Roy Thomas Daniel, Michele Zeverino, Marc Levivier, Mercy George, Etienne Pralong, Constantin Tuleasca, Raphael Maire
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Neurology
Original Article - Brain Tumors
medicine.medical_treatment
Gamma knife
Schwannoma
Radiosurgery
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Vestibular schwannoma
Aged
Cochlear Nerve/physiology
Cochlear Nerve/surgery
Facial Nerve/physiology
Facial Nerve/surgery
Female
Hearing
Humans
Middle Aged
Neuroma
Acoustic/surgery
Postoperative Complications/etiology
Postoperative Complications/prevention & control
Radiosurgery/adverse effects
Radiosurgery/methods
Combined approach
Surgery
medicine
Cochlear Nerve
Neuroradiology
medicine.diagnostic_test
business.industry
Cochlear nerve
Interventional radiology
Neuroma
Acoustic
medicine.disease
Facial nerve
Facial Nerve
030220 oncology & carcinogenesis
Neurology (clinical)
Neurosurgery
business
030217 neurology & neurosurgery
Zdroj: Acta Neurochirurgica
Acta neurochirurgica, vol. 159, no. 7, pp. 1197-1211
ISSN: 0942-0940
Popis: Objective To perform planned subtotal resection followed by gamma knife surgery (GKRS) in a series of patients with large vestibular schwannoma (VS), aiming at an optimal functional outcome for facial and cochlear nerves. Methods Patient characteristics, surgical and dosimetric features, and outcome were collected prospectively at the time of treatment and during the follow-up. Results A consecutive series of 32 patients was treated between July 2010 and June 2016. Mean follow-up after surgery was 29 months (median 24, range 4–78). Mean presurgical tumor volume was 12.5 cm3 (range 1.47–34.9). Postoperative status showed normal facial nerve function (House–Brackmann I) in all patients. In a subgroup of 17 patients with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 16 (94.1%) retained serviceable hearing. Among them, 13 had normal hearing (Gardner–Robertson class 1) before surgery, and 10 (76.9%) retained normal hearing after surgery. Mean duration between surgery and GKRS was 6.3 months (range 3.8–13.9). Mean tumor volume at GKRS was 3.5 cm3 (range 0.5–12.8), corresponding to mean residual volume of 29.4% (range 6–46.7) of the preoperative volume. Mean marginal dose was 12 Gy (range 11–12). Mean follow-up after GKRS was 24 months (range 3–60). Following GKRS, there were no new neurological deficits, with facial and hearing functions remaining identical to those after surgery in all patients. Three patients presented with continuous growth after GKRS, were considered failures, and benefited from the same combined approach a second time. Conclusion Our data suggest that large VS management, with planned subtotal resection followed by GKRS, might yield an excellent clinical outcome, allowing the normal facial nerve and a high level of cochlear nerve functions to be retained. Our functional results with this approach in large VS are comparable with those obtained with GKRS alone in small- and medium-sized VS. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.
Databáze: OpenAIRE
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