Title: Long-term outcomes after radiosurgery for acoustic neuromas.
Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC
Location: Department of Neurological Surgery, University of Pittsburgh, PA 15213, USA.
Source: N Engl J Med 1998 Nov 12;339(20):1426-33
BACKGROUND: Stereotactic radiosurgery is the principal alternative to microsurgical resection for acoustic neuromas(vestibular schwannomas). The goals of radiosurgery are the long-term prevention of tumor growth, maintenance of neurologic function, and prevention of new neurologic deficits. Although acceptable short-term outcomes have been reported, long-term outcomes have not been well documented.
METHODS: We evaluated 162 consecutive patients who underwent radiosurgery for acoustic neuromas between 1987 and 1992 by means of serial imaging tests, clinical evaluations, and a survey between 5and 10 years after the procedure. The average dose of radiation to the tumor margin was 16 Gy, and the mean transverse diameter of the tumor was 22 mm (range, 8 to 39). Resection had been performed previously in 42 patients (26 percent); in 13 patients the tumor represented a recurrence of disease after a previous total resection. Facial function was normal in 76 percentof the patients before radiosurgery, and 20 percent had useful hearing.
RESULTS: The rate of tumor control (with no resectionrequired) was 98 percent. One hundred tumors (62 percent) became smaller, 53 (33 percent) remained unchanged in size, and9 (6 percent) became slightly larger. Resection was performed in four patients (2 percent) within four years after radiosurgery.Normal facial function was preserved in 79 percent of the patients after five years (House-Brackmann grade 1), and normal trigeminal function was preserved in 73 percent. Fifty-one percent of the patients had no change in hearing ability. No new neurologic deficits appeared more than 28 months after radiosurgery. An outcomes questionnaire was returned by 115 patients (77 percent of the 149 patients still living). Fifty-four of these patients (47 percent) were employed at the time of radiosurgery,and 37 (69 percent) remained so. Radiosurgery was believed to have been successful by all 30 patients who had undergone surgery previously and by 81 (95 percent) of the 85 who had not. Thirty-six of the 115 patients (31 percent) described at least one complication, which resolved in 56 percent of those cases.
CONCLUSIONS: Radiosurgery can provide long-term control of acoustic neuromas while preserving neurologic function.
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