Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Abstract

The radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) is controversial. The authors investigated the radiologically proven tumor control rate after gamma knife radiosurgery. The factors that affect tumor control and serviceable hearing preservation were analyzed. Thirty-six lesions in 30 patients were included. The median lengths of the clinical and radiologic follow-ups were 48.5 months and 36.5 months, respectively. The median tumor volume was 3.2 cm3. The mean marginal dose was 12.1 grays (Gy) (range, 8-14 Gy) at an isodose line of 50%+/-0.6%. The Kaplan-Meier method and Cox proportional hazards model were used for the statistical analyses. The actuarial tumor control rate was 81%, 74%, and 66%, respectively, in the first, second, and fifth years. Five tumors required a salvage surgery because of tumor control failure. A low marginal dose and a young age at radiosurgery were associated with poor tumor control. Of the 16 tumors with which ipsilateral hearing was serviceable, the actuarial serviceable hearing preservation rates were 50%, 45%, and 33%, respectively, in the first, second, and fifth years. Better ipsilateral hearing (Gardner-Robertson grade 1, compared with grade 2) at the time of radiosurgery was associated with significantly greater serviceable hearing preservation. Gamma knife radiosurgery for vestibular schwannomas in NF2 patients provided 5-year tumor control in approximately two-thirds of patients and preserved serviceable hearing in approximately one-third. The rates of other cranial nerve deficits were low, and no secondary malignancy was observed. Radiosurgery should be included in treatment options for NF2 patients.