Abstract
Objective: To examine tumor control, hearing preservation, and complication rates after frameless fractionated stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).Methods: Thirty-seven patients treated with fractionated SRS from 2002 to 2011 were retrospectively analyzed. Ninety-five percent were treated with 25 Gy in five fractions, targeting a median tumor volume of 1.03 cc (range 0.14–7.60).Results: With a median follow-up of 4.25 years (range, 15 months–9 years), no tumors required an additional treatment resulting in 100% tumor control rate. Radiographic control rate was 91% in 32 patients at a median follow-up of 3 years. Of the 14 patients with serviceable hearing and with audiograms, the hearing preservation rate was 78% at a median follow-up of 18 months. Twenty-six patients with serviceable hearing pretreatment, were evaluated by a phone survey with a hearing preservation rate of 73% at a 5 year median follow-up. There were two cases that developed both new increased trigeminal parasthesias and facial spasms but there were no cases of facial weakness. Patient had 96% of good to excellent satisfaction rate with the treatment at a median follow-up of 5 years.Conclusion: Frameless fractionated SRS treatment of VS results in good rate of tumor control. Hearing preservation rate and rates of cranial nerve toxicity are comparable to what is reported in the literature. Patients choose this modality because of its non-invasive nature and are generally very satisfied with their long term outcome.
Highlights
Vestibular schwannomas (VS) are benign tumors arising mostly from vestibular component of the vestibulocochlear nerve
Hearing preservation rate and rates of cranial nerve toxicity are comparable to what is reported in the literature
Interventional tumor control rate was defined as the absence of the need for additional surgical or radiosurgical intervention according to the Stanford update series (Hansasuta et al, 2011)
Summary
Vestibular schwannomas (VS) are benign tumors arising mostly from vestibular component of the vestibulocochlear nerve. They constitute about 6% of intracranial neoplasms with an incidence of ∼9–13 per million people per year (Murphy and Suh, 2011). The unilateral or sporadic tumors are by far the most common, making up 95% of VS. Hearing loss is the most common initial presenting symptoms and is usually followed by tinnitus, disequilibrium, trigeminal nerve dysfunction, vertigo headache, facial nerve dysfunction, and diplopia (Stucken et al, 2012). Symptoms usually arise from tumor progression as it grows through the internal auditory canal through the cerebellopontine angle and eventually leading to compression of neighboring cranial nerves and the brainstem (Stucken et al, 2012).
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