Artikel
Comparative long-term results of microsurgery and gamma knife for vestibular schwannomas
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Autoren
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A. Rizk
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
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G. Lepski
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
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F.H. Ebner
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
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A.T.C.J.V. Eick
- Gamma Knife Zentrum Krefeld, Krefeld, Deutschland
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G.A. Horstmann
- Gamma Knife Zentrum Krefeld, Krefeld, Deutschland
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M. Tatagiba
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Deutschland
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Treatment of vestibular Schwannomas, especially the smaller ones, represents a matter of strong controversy, and to date no class I evidence can support the benefit of certain treatment modality over the others. Expectant treatment, microsurgery, and gamma knife represent the most important options to be considered. The main goal of the present study is to compare the functional outcome after gamma knife and surgical treatment in the long-term follow-up.
Methods: 269 patients submitted to microsurgery and 427 patients treated with gamma knife in two different centers were followed up for 15.2 ± 13.6 months and 45.6 ± 26.8 months respectively. Tumor volumetry based on serial MR images, facial nerve function according to the House-Brackman scale, hearing function according to the Gardner-Robertson scale, tinnitus, trigeminal symptoms, and vertigo were systematically analyzed and compared between both treatment modalities.
Results: Based on the normalized volumetry over time, surgery was more efficient than gamma knife on tumor control (p < 0.001). Nevertheless, functional results regarding facial nerve and hearing preservation favored radiotherapy over surgery (odds ratio 12.252 and 1.392, respectively). Gamma knife was also superior on the control of vertigo (OR 1.264). By contrast, surgery was more efficient on the control of trigeminal symptoms (OR 1.123) and tinnitus (OR 2.848)
Conclusions: Our results represent a further contribution to the field and offer evidence-based criteria to support the indication of one treatment modality according to patients' expectations and professional activity.
