Do we really still need an open surgery for treatment of patients with vestibular schwannomas?

Motohiro Hayashi, Mikhail F. Chernov, Samuel M. Lipski, Noriko Tamura, Shoji Yomo, Ayako Horiba, Shyunsuke Tsuzuki, Masahiro Izawa, Yoshikazu Okada, Yoshihiro Muragaki, Hiroshi Iseki, Pavel Ivanov, Jean Régis, Kintomo Takakura

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Gamma Knife surgery (GKS) should be considered a standard treatment option for small and medium-sized vestibular schwannomas (VSs). It results in a tumor control rate similar to that seen with microsurgery and provides better preservation of facial nerve function and hearing. From December 2002 to April 2011, a total of 260 patients with VS underwent GKS using Leksell Gamma Knife model 4C with an automatic positioning system. There were 30 Koos stage I tumors, 112 stage II, 100 stage III, and 18 stage IV. All patients were treated with the use of high-resolution magnetic resonance imaging; creation of the highly precise conformal and selective multi-isocenter dose planning with small collimators, carefully sparing adjacent cranial nerves of any excessive irradiation; and creation of a wide 80 % isodose area within the tumor while applying a low marginal dose (mean 11.9 Gy) at the 50 % isodose line. Among 182 patients who were followed for more than 3 years after treatment, the tumor control and shrinkage rates were 98.4 % and 76.4 %, respectively. Volume reduction of >50 % was marked in 54.9 % of VSs. Preservation of facial nerve function and hearing at the pretreatment level was noted in 97.8 % and 87.9 %, respectively. There was marked improvement of facial nerve function and hearing after GKS in 2.2 % and 3.8 %, respectively. There was no major morbidity. Due to contemporary technological and methodological achievements GKS can be focused not only on growth control but on shrinking the VS, with possible reversal of the neurological deficit.

Original languageEnglish
Pages (from-to)25-36
Number of pages12
JournalActa neurochirurgica. Supplement
Volume116
Publication statusPublished - 2013
Externally publishedYes

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Acoustic Neuroma
Facial Nerve
Hearing
Neoplasms
Microsurgery
Cranial Nerves
Therapeutics
Magnetic Resonance Imaging
Morbidity
Growth

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Hayashi, M., Chernov, M. F., Lipski, S. M., Tamura, N., Yomo, S., Horiba, A., ... Takakura, K. (2013). Do we really still need an open surgery for treatment of patients with vestibular schwannomas? Acta neurochirurgica. Supplement, 116, 25-36.

Do we really still need an open surgery for treatment of patients with vestibular schwannomas? / Hayashi, Motohiro; Chernov, Mikhail F.; Lipski, Samuel M.; Tamura, Noriko; Yomo, Shoji; Horiba, Ayako; Tsuzuki, Shyunsuke; Izawa, Masahiro; Okada, Yoshikazu; Muragaki, Yoshihiro; Iseki, Hiroshi; Ivanov, Pavel; Régis, Jean; Takakura, Kintomo.

In: Acta neurochirurgica. Supplement, Vol. 116, 2013, p. 25-36.

Research output: Contribution to journalArticle

Hayashi, M, Chernov, MF, Lipski, SM, Tamura, N, Yomo, S, Horiba, A, Tsuzuki, S, Izawa, M, Okada, Y, Muragaki, Y, Iseki, H, Ivanov, P, Régis, J & Takakura, K 2013, 'Do we really still need an open surgery for treatment of patients with vestibular schwannomas?', Acta neurochirurgica. Supplement, vol. 116, pp. 25-36.
Hayashi M, Chernov MF, Lipski SM, Tamura N, Yomo S, Horiba A et al. Do we really still need an open surgery for treatment of patients with vestibular schwannomas? Acta neurochirurgica. Supplement. 2013;116:25-36.
Hayashi, Motohiro ; Chernov, Mikhail F. ; Lipski, Samuel M. ; Tamura, Noriko ; Yomo, Shoji ; Horiba, Ayako ; Tsuzuki, Shyunsuke ; Izawa, Masahiro ; Okada, Yoshikazu ; Muragaki, Yoshihiro ; Iseki, Hiroshi ; Ivanov, Pavel ; Régis, Jean ; Takakura, Kintomo. / Do we really still need an open surgery for treatment of patients with vestibular schwannomas?. In: Acta neurochirurgica. Supplement. 2013 ; Vol. 116. pp. 25-36.
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abstract = "Gamma Knife surgery (GKS) should be considered a standard treatment option for small and medium-sized vestibular schwannomas (VSs). It results in a tumor control rate similar to that seen with microsurgery and provides better preservation of facial nerve function and hearing. From December 2002 to April 2011, a total of 260 patients with VS underwent GKS using Leksell Gamma Knife model 4C with an automatic positioning system. There were 30 Koos stage I tumors, 112 stage II, 100 stage III, and 18 stage IV. All patients were treated with the use of high-resolution magnetic resonance imaging; creation of the highly precise conformal and selective multi-isocenter dose planning with small collimators, carefully sparing adjacent cranial nerves of any excessive irradiation; and creation of a wide 80 {\%} isodose area within the tumor while applying a low marginal dose (mean 11.9 Gy) at the 50 {\%} isodose line. Among 182 patients who were followed for more than 3 years after treatment, the tumor control and shrinkage rates were 98.4 {\%} and 76.4 {\%}, respectively. Volume reduction of >50 {\%} was marked in 54.9 {\%} of VSs. Preservation of facial nerve function and hearing at the pretreatment level was noted in 97.8 {\%} and 87.9 {\%}, respectively. There was marked improvement of facial nerve function and hearing after GKS in 2.2 {\%} and 3.8 {\%}, respectively. There was no major morbidity. Due to contemporary technological and methodological achievements GKS can be focused not only on growth control but on shrinking the VS, with possible reversal of the neurological deficit.",
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