gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Conformal stereotactic radiosurgery for vestibular schwannoma

Behandlung vestibulärer Schwannome durch konformale stereotaktische Radiochirurgie

Meeting Abstract

  • corresponding author Reinhard E. Wurm - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Radiation Oncology, Charité CCM, Berlin
  • L. Schlenger - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Radiation Oncology, Charité CCM, Berlin
  • D. Scheffler - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Radiation Oncology, Charité CCM, Berlin
  • J. Zierski - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Neurosurgery, Academic Teaching Hospital, Charité, Humboldt University, Berlin
  • A. Unterberg - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Neurosurgery, Charité CVK, Berlin
  • V. Budach - Stereotactic Radiosurgery and Radiotherapy Programme Charité, Department of Radiation Oncology, Charité CCM, Berlin

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.03.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0263.shtml

Veröffentlicht: 23. April 2004

© 2004 Wurm et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective

To assess the feasibility of single isocenter conformal stereotactic radiosurgery for vestibular schwannoma.

Methods

From February 1998 to February 2002, 74 consecutive previously untreated patients (median age: 63 years, range: 26-81 years) with vestibular schwannoma (median volume: 1.74 cm3, range: 0.14-3.7 cm3) were prospectively treated. The median follow-up time is 24.3 months, with 42 patients having a follow-up of at least 24 months. In 33% of patients the vestibular schwannoma was located on the left side and in 67% on the right side. Twelve patients had only intrameatal growth and in 29 patients the vestibular schwannoma had brainstem contact. On initial presentation eleven patients complained about trigeminal neuralgia as the leading symptom, and 3 patients complained about a grade II facial nerve neuropathy according to House-Brackmann. Vertigo was the main complaint in ten and tinnitus in 26 patients. In all patients target delineation and treatment planning was based on CT and MRI image fusion. Patients were treated with the Novalis high-resolution bream shaper (m3 mMLC) using 6 to 11 static beams (28 patients) or 3 Dynamic Conformal Arcs (45 patients). In all patients the isocenter dose was limited to 13.5 Gy and at the periphery to 12 Gy resulting in a conformity index of 1.4 to 2.1 (median 1.7) and a homogeneity index of 1.15 according to the guidelines of the Radiation Therapy Oncology Group (RTOG).

Results

Deterioration in pre-treatment impaired hearing was noted in 16% patients. Improved hearing was found in 12%, and no change in 72% of patients. A temporary facial nerve weakness was observed in 1 patient with an intrameatal schwannoma. Temporary impairment of trigeminal neuropathy was seen in 8%, an improvement in 44% of the cases. Only 1 patient developed a temporary trigeminal neuropathy as a new complaint. Impaired dizzy-vertigo was observed in 20%, no change in 20% and improvement in 20% of patients. A decrease in tumour volume was found in 67% of patients and no patient has shown progression.

Conclusions

To date conformal stereotactic radiosurgery for vestibular schwannoma provided excellent local control and only minimal acute and late side effects.