Fractionated Stereotactic Radiosurgery and Preservation of Hearing in Patients with Vestibular Schwannoma: A Preliminary Report

Fractionated Stereotactic Radiosurgery and Preservation of Hearing in Patients with Vestibular... AbstractOBJECTIVE:Microsurgery and stereotactic radiosurgery (SRS) for vestibular schwannomas are associated with a relatively high incidence of sensorineural hearing loss. A prospective trial of fractionated SRS was undertaken in an attempt to preserve hearing and minimize incidental cranial nerve injury.METHODS:Thirty-three patients with vestibular schwannomas were treated with 2100 cGy in three fractions during a 24-hour period using conventional frame-based linear accelerator radiosurgery. The median tumor diameter was 20 mm (range, 7-42 mm). Baseline and follow-up evaluations included audiometry and contrast-enhanced magnetic resonance imaging. End points were tumor progression, preservation of serviceable hearing, and treatment-related complications.RESULTS:Thirty-one patients (32 tumors) were assessable for tumor progression and treatment-related complications and 21 patients for preservation of serviceable hearing, with a median follow-up interval of 2 years (range, 0.5-4.0 yr). Tumor regression or stabilization was documented in 30 patients (97%) and tumor progression in 1 (3%). The patient with tumor progression remains asymptomatic and has not required surgical intervention. Five patients (16%) developed trigeminal nerve injury at a median of 6 months (range, 4-12 mo) after SRS; two of these patients had preexisting trigeminal neuropathy. One patient (3%) developed facial nerve injury (House-Brackmann Class 3) 7 months after SRS. Preservation of useful hearing (Gardner-Robertson Class 1-2) was 77% at 2 years. All patients with pretreatment Gardner-Robertson Class 1 to 2 hearing maintained serviceable (Class 1-3) hearing as of their last follow-up examination.CONCLUSION:Three-fraction SRS with a conventional stereotactic frame is feasible and well tolerated in the treatment of acoustic neuroma. This study demonstrates a high rate of hearing preservation and few treatment- related complications among a relatively high-risk patient cohort (tumors >15 mm or neurofibromatosis Type 2). Longer follow-up will be required to assess the durability of tumor control. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Fractionated Stereotactic Radiosurgery and Preservation of Hearing in Patients with Vestibular Schwannoma: A Preliminary Report

Fractionated Stereotactic Radiosurgery and Preservation of Hearing in Patients with Vestibular Schwannoma: A Preliminary Report

Fractionated Stereotactic Radiosurgery and Preservation of Hearing in Patients with Vestibular Schwannoma: A Preliminary Report Joseph C. Poen, M.D., Alexandra J. Golby, M.D., Kenneth M. Forster, Ph.D., David P. Martin, M.D., Daniel M. Chinn, M.D., Steven L. Hancock, M.D., John R. Adler, Jr., M.D. Departments ot Radiation Oncology (JCP, KMF, DMC, SLH, ]RA) and Neurosurgery (A)G, DPM, JRA), Stanford University School of Medicine, Stanford, California O BJECTIVE: M icrosurgery and stereotactic radiosurgery (SRS) for vestibular schwannomas are associated w ith a relatively high incidence of sensorineural hearing loss. A prospective trial of fractionated SRS was undertaken in an attempt to preserve hearing and m inim ize incidental cranial nerve injury. M ETHODS: Thirty-three patients w ith vestibular schwannomas w ere treated with 2100 cG y in three fractions during a 24-hour period using conventional frame-based linear accelerator radiosurgery. The median tumor diam eter was 20 mm (range, 7-42 mm). Baseline and follow-up evaluations included audiom etry and contrast-enhanced magnetic resonance imaging. End points w ere tumor progression, preservation of serviceable hearing, and treatment-related com plications. RESULTS: Thirty-one patients (32 tumors) w ere assessable for tumor progression and treatment-related com plica­ tions and 21 patients for preservation of serviceable hearing, with a median follow-up interval of 2 years (range, 0.5-4.0 yr). Tum or regression or stabilization was documented in 30 patients (9 7 % ) and tumor progression in 1 (3 % ). The patient w ith tum or progression remains asymptom atic and has not required surgical intervention. Five patients (1 6 % ) developed trigem inal nerve injury at a median of 6 months (range, 4-12 mo) after SRS; two of these patients had preexisting trigem inal neuropathy. O ne patient (3 % ) developed facial nerve injury (House- Brackmann Class 3) 7 months after SRS. Preservation of useful hearing...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199912000-00004
Publisher site
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Abstract

AbstractOBJECTIVE:Microsurgery and stereotactic radiosurgery (SRS) for vestibular schwannomas are associated with a relatively high incidence of sensorineural hearing loss. A prospective trial of fractionated SRS was undertaken in an attempt to preserve hearing and minimize incidental cranial nerve injury.METHODS:Thirty-three patients with vestibular schwannomas were treated with 2100 cGy in three fractions during a 24-hour period using conventional frame-based linear accelerator radiosurgery. The median tumor diameter was 20 mm (range, 7-42 mm). Baseline and follow-up evaluations included audiometry and contrast-enhanced magnetic resonance imaging. End points were tumor progression, preservation of serviceable hearing, and treatment-related complications.RESULTS:Thirty-one patients (32 tumors) were assessable for tumor progression and treatment-related complications and 21 patients for preservation of serviceable hearing, with a median follow-up interval of 2 years (range, 0.5-4.0 yr). Tumor regression or stabilization was documented in 30 patients (97%) and tumor progression in 1 (3%). The patient with tumor progression remains asymptomatic and has not required surgical intervention. Five patients (16%) developed trigeminal nerve injury at a median of 6 months (range, 4-12 mo) after SRS; two of these patients had preexisting trigeminal neuropathy. One patient (3%) developed facial nerve injury (House-Brackmann Class 3) 7 months after SRS. Preservation of useful hearing (Gardner-Robertson Class 1-2) was 77% at 2 years. All patients with pretreatment Gardner-Robertson Class 1 to 2 hearing maintained serviceable (Class 1-3) hearing as of their last follow-up examination.CONCLUSION:Three-fraction SRS with a conventional stereotactic frame is feasible and well tolerated in the treatment of acoustic neuroma. This study demonstrates a high rate of hearing preservation and few treatment- related complications among a relatively high-risk patient cohort (tumors >15 mm or neurofibromatosis Type 2). Longer follow-up will be required to assess the durability of tumor control.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1999

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