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Cranial Nerve Preservation After Stereotactic Radiosurgery for Small Acoustic Tumors

Cranial Nerve Preservation After Stereotactic Radiosurgery for Small Acoustic Tumors Abstract Objective: To assess those factors associated with and predictive of cranial nerve preservation after stereotactic radiosurgery in patients with small acoustic tumors identified by magnetic resonance imaging. Design: We performed a retrospective analysis of our experience with 31 patients with preserved hearing and acoustic tumors measuring 10 mm or smaller (pons-to-petrous dimension). All patients underwent clinical and audiologic evaluations varying from 6 to 48 months (mean, 20 months) after stereotactic radiosurgery performed with use of the 201 source cobalt 60 gamma unit. Results: Stabilization or reduction in tumor volume was achieved in 29 of 31 patients. One patient required delayed microsurgical resection. Useful hearing (pure tone average ≤50 dB and speech discrimination score ≥50%) preservation was achieved in 10 of 10 patients immediately postoperatively, eight of 10 patients at 6 months, six of 10 patients at 1 year, and five of 10 at 2 years. Preservation of some measurable hearing was possible in all patients immediately after radiosurgery, in 84% and in more than half of patients at 2 years. Preoperative facial nerve function was preserved in 19 of 20 patients at 2 years after radiosurgery. All patients returned to their preoperative employment status within 2 to 5 days after radiosurgery. Conclusion: Stereotactic radiosurgery performed with current technology (multiple radiation isocenters and magnetic resonance imaging guidance) is a safe and effective management strategy for patients with small acoustic tumors. The risk of facial and trigeminal neuropathy after gamma knife radiosurgery is low, and useful hearing can be preserved in up to 50% of patients with useful preoperative hearing. Stereotactic radiosurgery is a valuable alternative strategy to surgical removal for many patients with newly diagnosed small acoustic tumors. References 1. Leksell L. A note on the treatment of acoustic tumors . Acta Chir Scand . 1971; 137:763-765. 2. Lunsford LD, Flickinger J, Coffey RJ. Stereotactic gamma knife radiosurgery: initial North American experience in 207 patients . Arch Neurol . 1990;47:169-175.Crossref 3. Noren G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neuroma: further experiences . Neurosurgery . 1983;13:12-22.Crossref 4. Noren G, Arndt J, Hindmarsh T, Hirsch A. Stereotactic radiosurgical treatment of acoustic neurinomas . In: Lunsford LD, ed. Modern Stereotactic Neurosurgery . Boston, Mass: Martinus Nijhoff Publishing; 1988:481-489. 5. Lunsford LD, Kamerer DK, Flickinger JC. Stereotactic radiosurgery of acoustic neurinoma . Arch Otolaryngol Head Neck Surg . 1990;116:907-909.Crossref 6. Linskey ME, Lunsford LD, Flickinger JG. Radiosurgery for acoustic neurinomas: early experience . Neurosurgery . 1990;26:736-745.Crossref 7. Lunsford LD, Linskey ME, Flickinger JC. Stereotactic radiosurgery for acoustic nerve sheath tumors . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:279-287. 8. Hirsch A, Noren G. Audiological evaluation after stereotactic radiosurgery in acoustic neuromas . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:293-295. 9. Ganz JC, Mathisen JR, Thorsen F, Backlund EO. Acoustic Neurinoma: early results related to radiological variables . In: Lunsford LD, ed. Stereotactic Radiosurgery Update . New York, NY: Elsevier Science Publishing Co Inc; 1992: 359-363. 10. Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery . Ann Otol Rhinol Laryngol . 1988;97:55-66. 11. Silverstein H, McDaniel A, Norrell H, Habenkamp T. Hearing preservation after acoustic neuroma surgery with intraoperative direct eighth cranial nerve monitoring, II: a classification of results . Otolaryngol Head Neck Surg . 1986;95: 258-291. 12. House JW, Brackmann DE. Facial nerve grading system . Otolaryngol Head Neck Surg . 1985;93:146-147. 13. Lunsford LD, Linskey ME. Stereotactic radiosurgery in the treatment of patients with acoustic tumors . Otolaryngol Clin North Am . 1992;25:471-491. 14. Lunsford LD, Kondziolka D, Flickinger J. Radiosurgery as an alternative to microsurgery of acoustic tumors . Clin Neurosurg . 1992;38:619-634. 15. Wiegand DA, Fickel V. Acoustic neuromas: the patient's perspective: subjective assessment of symptoms, diagnosis, therapy and outcome in 541 patients . Laryngoscope . 1989;99:179-187.Crossref 16. Gantz BJ, Parnes LS, Harker LA, McCabe BF. Middle cranial fossa acoustic neuroma excision: results and complications . Ann Otol Rhinol Laryngol . 1986; 95:454-459. 17. Frerebau MD, Berezech J, Uziel A, Coubes P, Segnarbieux F, Malonga M. Hearing preservation after acoustic neuroma operation . Neurosurgery . 1987;21: 197-200.Crossref 18. Bentiroglio P, Cheeseman AD, Symon L. Surgical management of acoustic neuromas during the last five years, II: results for fiscal and cochlear nerve function . Surg Neurol . 1988;29:205-209.Crossref 19. Shelton C, Brackmann DE, House WF, Hitselberger WE. Middle fossa acoustic tumor surgery: results in 106 cases . Laryngoscope . 1989;99:405-408.Crossref 20. Nadol JB Jr, Levine R, Ojeman RG, Martuza RL, Montgomery WN. Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellopontine angle . Laryngoscope . 1987;97:1287-1294.Crossref 21. Wade PJ, House W. Hearing preservation in patients with acoustic neuromas via the middle fossa approach . Otolaryngol Head Neck Surg . 1984;92:184-193. 22. Sanna M, Zuni C, Gamoletti R, Landolfi M, Shaan M, Piazza F. Hearing preservation: a critical review of the literature . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:631-638. 23. Cohen NL. Acoustic neuroma surgery with emphasis on preservation of hearing . Laryngoscope . 1985;16:801-803. 24. Cohen NL, Hammerschlag P, Berg H, Ransohoff J. Acoustic neuroma surgery: an eclectic approach with emphasis on preservation of hearing . Ann Otol Rhinol Laryngol . 1986;95:21-29. 25. Frerebeau MD, Benezech J, Uziel A, Combes T, Segnarbieux F, Malinga M. Hearing preservation after acoustic neurinoma operation . Neurosurgery . 1987; 21:197-200.Crossref 26. Glasscock ME, Kvetor JK, Levine SC, Jackson CG, McKenna KX. A systematic approach to the surgical management of acoustic neuroma . Laryngoscope . 1986; 96:1088-1094.Crossref 27. Long DM, Kennedy DW, Holliday MJ. Selecting a surgical approach for removal of acoustic schwannoma . Ear Nose Throat J . 1986;65:163-173. 28. Tos M, Thomsen J. Epidemiology of acoustic neuromas . J Laryngol Otol . 1984; 98:685-692.Crossref 29. Lunsford LD, Flickenger J, Lindner G, Maitz A. Stereotactic radiosurgery of the brain using the first United States 201 cobalt 60 source gamma knife . Neurosurgery . 1989;24:151-159.Crossref 30. Leksell L. Stereotactic radiosurgery . J Neurol Neurosurg Psychiatry . 1983;46: 797-803.Crossref 31. Noren G, Greitz D, Hirsch A, Lax L. Gamma knife radiosurgery in acoustic neuromas . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:289-292. 32. Hagerman B. Reliability in the determination of speech discrimination . Scand Audiol . 1976;5:219-228.Crossref 33. Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor radiosurgery . Int J Radiat Oncol Biol Phys . 1993;25:227-233.Crossref 34. Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors . Neurosurg Clin North Am . 1992;3:191-205. 35. McKenna MJ, Halpin C, Ojamen RG, et al. Long-term hearing results in patients after surgical removal of acoustic tumors with hearing preservation . Am J Otol . 1992;13:134-136. 36. Shelton C, Hitselberger WE, House WF, Brackmann DE. Hearing preservation after acoustic tumor removal: long-term results . Laryngoscope . 1990;100:115-119. 37. Palva T, Troupp H, Jauhiainer T. Hearing preservation in acoustic neuroma surgery . Acta Otolaryngol . 1985;99:1-7.Crossref 38. Atlas MD, Harvey C, Fagan P. Acoustic neuroma hearing preservation surgery: five-year follow-up results . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:681-687. 39. Goel A, Sekhar LN, Langheinrich W, Kamerer D, Hirsch B. Late course of preserved hearing and tinnitus after acoustic neurilemoma surgery . J Neurosurg . 1992;77:685-689.Crossref 40. Noren G, Greitz D, Hirsh A, Lax L. Gamma knife radiosurgery in acoustic neurinoma . In: Steiner L, ed. Radiosurgery Baseline and Trends . New York, NY: Raven Press; 1992:141-148. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Cranial Nerve Preservation After Stereotactic Radiosurgery for Small Acoustic Tumors

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1995.00540250077016
Publisher site
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Abstract

Abstract Objective: To assess those factors associated with and predictive of cranial nerve preservation after stereotactic radiosurgery in patients with small acoustic tumors identified by magnetic resonance imaging. Design: We performed a retrospective analysis of our experience with 31 patients with preserved hearing and acoustic tumors measuring 10 mm or smaller (pons-to-petrous dimension). All patients underwent clinical and audiologic evaluations varying from 6 to 48 months (mean, 20 months) after stereotactic radiosurgery performed with use of the 201 source cobalt 60 gamma unit. Results: Stabilization or reduction in tumor volume was achieved in 29 of 31 patients. One patient required delayed microsurgical resection. Useful hearing (pure tone average ≤50 dB and speech discrimination score ≥50%) preservation was achieved in 10 of 10 patients immediately postoperatively, eight of 10 patients at 6 months, six of 10 patients at 1 year, and five of 10 at 2 years. Preservation of some measurable hearing was possible in all patients immediately after radiosurgery, in 84% and in more than half of patients at 2 years. Preoperative facial nerve function was preserved in 19 of 20 patients at 2 years after radiosurgery. All patients returned to their preoperative employment status within 2 to 5 days after radiosurgery. Conclusion: Stereotactic radiosurgery performed with current technology (multiple radiation isocenters and magnetic resonance imaging guidance) is a safe and effective management strategy for patients with small acoustic tumors. The risk of facial and trigeminal neuropathy after gamma knife radiosurgery is low, and useful hearing can be preserved in up to 50% of patients with useful preoperative hearing. Stereotactic radiosurgery is a valuable alternative strategy to surgical removal for many patients with newly diagnosed small acoustic tumors. References 1. Leksell L. A note on the treatment of acoustic tumors . Acta Chir Scand . 1971; 137:763-765. 2. Lunsford LD, Flickinger J, Coffey RJ. Stereotactic gamma knife radiosurgery: initial North American experience in 207 patients . Arch Neurol . 1990;47:169-175.Crossref 3. Noren G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neuroma: further experiences . Neurosurgery . 1983;13:12-22.Crossref 4. Noren G, Arndt J, Hindmarsh T, Hirsch A. Stereotactic radiosurgical treatment of acoustic neurinomas . In: Lunsford LD, ed. Modern Stereotactic Neurosurgery . Boston, Mass: Martinus Nijhoff Publishing; 1988:481-489. 5. Lunsford LD, Kamerer DK, Flickinger JC. Stereotactic radiosurgery of acoustic neurinoma . Arch Otolaryngol Head Neck Surg . 1990;116:907-909.Crossref 6. Linskey ME, Lunsford LD, Flickinger JG. Radiosurgery for acoustic neurinomas: early experience . Neurosurgery . 1990;26:736-745.Crossref 7. Lunsford LD, Linskey ME, Flickinger JC. Stereotactic radiosurgery for acoustic nerve sheath tumors . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:279-287. 8. Hirsch A, Noren G. Audiological evaluation after stereotactic radiosurgery in acoustic neuromas . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:293-295. 9. Ganz JC, Mathisen JR, Thorsen F, Backlund EO. Acoustic Neurinoma: early results related to radiological variables . In: Lunsford LD, ed. Stereotactic Radiosurgery Update . New York, NY: Elsevier Science Publishing Co Inc; 1992: 359-363. 10. Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery . Ann Otol Rhinol Laryngol . 1988;97:55-66. 11. Silverstein H, McDaniel A, Norrell H, Habenkamp T. Hearing preservation after acoustic neuroma surgery with intraoperative direct eighth cranial nerve monitoring, II: a classification of results . Otolaryngol Head Neck Surg . 1986;95: 258-291. 12. House JW, Brackmann DE. Facial nerve grading system . Otolaryngol Head Neck Surg . 1985;93:146-147. 13. Lunsford LD, Linskey ME. Stereotactic radiosurgery in the treatment of patients with acoustic tumors . Otolaryngol Clin North Am . 1992;25:471-491. 14. Lunsford LD, Kondziolka D, Flickinger J. Radiosurgery as an alternative to microsurgery of acoustic tumors . Clin Neurosurg . 1992;38:619-634. 15. Wiegand DA, Fickel V. Acoustic neuromas: the patient's perspective: subjective assessment of symptoms, diagnosis, therapy and outcome in 541 patients . Laryngoscope . 1989;99:179-187.Crossref 16. Gantz BJ, Parnes LS, Harker LA, McCabe BF. Middle cranial fossa acoustic neuroma excision: results and complications . Ann Otol Rhinol Laryngol . 1986; 95:454-459. 17. Frerebau MD, Berezech J, Uziel A, Coubes P, Segnarbieux F, Malonga M. Hearing preservation after acoustic neuroma operation . Neurosurgery . 1987;21: 197-200.Crossref 18. Bentiroglio P, Cheeseman AD, Symon L. Surgical management of acoustic neuromas during the last five years, II: results for fiscal and cochlear nerve function . Surg Neurol . 1988;29:205-209.Crossref 19. Shelton C, Brackmann DE, House WF, Hitselberger WE. Middle fossa acoustic tumor surgery: results in 106 cases . Laryngoscope . 1989;99:405-408.Crossref 20. Nadol JB Jr, Levine R, Ojeman RG, Martuza RL, Montgomery WN. Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellopontine angle . Laryngoscope . 1987;97:1287-1294.Crossref 21. Wade PJ, House W. Hearing preservation in patients with acoustic neuromas via the middle fossa approach . Otolaryngol Head Neck Surg . 1984;92:184-193. 22. Sanna M, Zuni C, Gamoletti R, Landolfi M, Shaan M, Piazza F. Hearing preservation: a critical review of the literature . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:631-638. 23. Cohen NL. Acoustic neuroma surgery with emphasis on preservation of hearing . Laryngoscope . 1985;16:801-803. 24. Cohen NL, Hammerschlag P, Berg H, Ransohoff J. Acoustic neuroma surgery: an eclectic approach with emphasis on preservation of hearing . Ann Otol Rhinol Laryngol . 1986;95:21-29. 25. Frerebeau MD, Benezech J, Uziel A, Combes T, Segnarbieux F, Malinga M. Hearing preservation after acoustic neurinoma operation . Neurosurgery . 1987; 21:197-200.Crossref 26. Glasscock ME, Kvetor JK, Levine SC, Jackson CG, McKenna KX. A systematic approach to the surgical management of acoustic neuroma . Laryngoscope . 1986; 96:1088-1094.Crossref 27. Long DM, Kennedy DW, Holliday MJ. Selecting a surgical approach for removal of acoustic schwannoma . Ear Nose Throat J . 1986;65:163-173. 28. Tos M, Thomsen J. Epidemiology of acoustic neuromas . J Laryngol Otol . 1984; 98:685-692.Crossref 29. Lunsford LD, Flickenger J, Lindner G, Maitz A. Stereotactic radiosurgery of the brain using the first United States 201 cobalt 60 source gamma knife . Neurosurgery . 1989;24:151-159.Crossref 30. Leksell L. Stereotactic radiosurgery . J Neurol Neurosurg Psychiatry . 1983;46: 797-803.Crossref 31. Noren G, Greitz D, Hirsch A, Lax L. Gamma knife radiosurgery in acoustic neuromas . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:289-292. 32. Hagerman B. Reliability in the determination of speech discrimination . Scand Audiol . 1976;5:219-228.Crossref 33. Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor radiosurgery . Int J Radiat Oncol Biol Phys . 1993;25:227-233.Crossref 34. Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors . Neurosurg Clin North Am . 1992;3:191-205. 35. McKenna MJ, Halpin C, Ojamen RG, et al. Long-term hearing results in patients after surgical removal of acoustic tumors with hearing preservation . Am J Otol . 1992;13:134-136. 36. Shelton C, Hitselberger WE, House WF, Brackmann DE. Hearing preservation after acoustic tumor removal: long-term results . Laryngoscope . 1990;100:115-119. 37. Palva T, Troupp H, Jauhiainer T. Hearing preservation in acoustic neuroma surgery . Acta Otolaryngol . 1985;99:1-7.Crossref 38. Atlas MD, Harvey C, Fagan P. Acoustic neuroma hearing preservation surgery: five-year follow-up results . In: Tos M, Thomsen J, eds. Acoustic Neuroma . New York, NY: Kugler Publications; 1992:681-687. 39. Goel A, Sekhar LN, Langheinrich W, Kamerer D, Hirsch B. Late course of preserved hearing and tinnitus after acoustic neurilemoma surgery . J Neurosurg . 1992;77:685-689.Crossref 40. Noren G, Greitz D, Hirsh A, Lax L. Gamma knife radiosurgery in acoustic neurinoma . In: Steiner L, ed. Radiosurgery Baseline and Trends . New York, NY: Raven Press; 1992:141-148.

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1995

References