Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods

TLDR

The study aimed to evaluate tumor control and complications of current gamma‑knife radiosurgery for untreated unilateral acoustic neuroma. A cohort of 190 patients received gamma‑knife radiosurgery with marginal doses 11–18 Gy (median 13 Gy), maximum doses 22–36 Gy (median 26 Gy), and treatment volumes 0.1–33 cm³ (median 2.7 cm³), followed for a median of 30 months. Five‑year actuarial tumor control was 97.1 %, with low rates of new facial weakness (1.1 %) and numbness (2.6 %), hearing preservation 71 %, and speech discrimination 91 %; higher marginal doses increased facial weakness and reduced speech preservation, yet overall morbidity remained lower than earlier reports.

Abstract

The goal of this study was to define tumor control and complications of radiosurgery encountered using current treatment methods for the initial management of patients with unilateral acoustic neuroma.One hundred ninety patients with previously untreated unilateral acoustic neuromas (vestibular schwannomas) underwent gamma knife radiosurgery between 1992 and 1997. The median follow-up period in these patients was 30 months (maximum 85 months). The marginal radiation doses were 11 to 18 Gy (median 13 Gy), the maximum doses were 22 to 36 Gy (median 26 Gy), and the treatment volumes were 0.1 to 33 cm3 (median 2.7 cm3). The actuarial 5-year clinical tumor-control rate (no requirement for surgical intervention) for the entire series was 97.1+/-1.9%. Five-year actuarial rates for any new facial weakness, facial numbness, hearing-level preservation, and preservation of testable speech discrimination were 1.1+/-0.8%, 2.6+/-1.2%, 71+/-4.7%, and 91+/-2.6%, respectively. Facial weakness did not develop in any patient who received a marginal dose of less than 15 Gy (163 patients). Hearing levels improved in 10 (7%) of 141 patients who exhibited decreased hearing (Gardner-Robertson Classes II-V) before undergoing radiosurgery. According to multivariate analysis, increasing marginal dose correlated with increased development of facial weakness (p = 0.0342) and decreased preservation of testable speech discrimination (p = 0.0122).Radiosurgery for acoustic neuroma performed using current procedures is associated with a continued high rate of tumor control and lower rates of posttreatment morbidity than those published in earlier reports.