gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Radiosurgical treatment of vestibular schwannoma after incomplete resection due to functional aspects: an outcome analysis

Meeting Abstract

  • A.D. Djodari-Irani - Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • C. Schwartz - Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • A. Muacevic - Europäisches Cyberknife Zentrum München-Großhadern
  • B. Wowra - Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • J.C. Tonn - Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, München
  • C. Schichor - Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Großhadern, München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.12.10

DOI: 10.3205/12dgnc275, URN: urn:nbn:de:0183-12dgnc2755

Published: June 4, 2012

© 2012 Djodari-Irani et al.
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Outline

Text

Objective: In modern neurosurgery, preservation of cranial nerve (CN) function (fct) is crucial in patients suffering from vestibular schwannoma (VS), resulting in subtotal resection in selected cases. In case of tumor growth, second-line radiosurgery (RS) might imply additive risks for neurological deterioration. Therefore, we analyzed treatment toxicity for CN function in patients selected for RS after primary microsurgical resection, focusing on development of new or worsening of pre-existing deficits.

Methods: We retrospectively evaluated 64 patients with VS who had undergone gamma-/ cyberknife therapy after prior microsurgical resection over the last 10 yrs. 51 patients (m:f = 1.1:1, mean age 47.9 ± 16.3 yrs) with sufficient follow-up (FU)-data (review of medical charts, telephone interviews) were included. Indication for secondary RS was mainly tumor recurrence or remnant progress (78%). Median follow-up for all patients after RS was 42.9 ± 42.2 mths with median time span between operation and RS of 29.1 ± 49 mths. We analyzed CN fct (V,VII,VIII) before/after RS.

Results: A new neurological deficit was detected in 8 patients, which corresponds to 16% of the whole patient cohort. In detail, 7 patients suffered from a new N.V affection, in 2 patients a new N.VII palsy was documented. In patients with pre-RS deficits, further deterioration was a rare event. In detail, only 1 patient with a N.V affection deteriorated, whereas 9 (69%) remained unchanged and 3 (23%) patients improved during observation. Pre-existing N.VII affection worsened in 3 cases (8%), but improved in 13 (23%) cases until last FU. Only 2 patients with serviceable hearing (Gardner Robertson (GR) I, II) after incomplete VS resection were included, of whom 1 suffered from deafness, whereas the other one remained stable. Pre-existing hearing deficits (GR III) worsened after RS in 2 patients. Improvement of hearing fct was detected in 2 patients.

Conclusions: Second-line RS after previously performed microsurgical resection of VS appears to be associated with tolerable risk for development of new neurological deficits, mainly affecting N. V fct. In cases with pre-existing deficits, we found a low risk for symptom deterioration after second-line RS. Taken together, in selected cases of VS, subsequent microsurgical and RS treatment appears to be a reasonable concept under functional aspects.