gms | German Medical Science

Radiotherapy of vestibular schwannoma is an important treatment option today.

The functional results of a one-time or a fractionated stereotactic radiotherapy were collected in a prospective study. 62 patients who were treated between 1998 and 2005 were included into this analysis. The medial follow up was 2.5 years and the average age was 60 years (from 32 to 81 years). Tumours with a longitudinal diameter less than 1.5 cm (41 patients) were radiated in a one-time stereotactic radiation of 12 Gy (“radiosurgery”). Tumours larger than 1.5 cm (21 patients) were radiated in 30 sessions of 1.8 Gy with a cumulative dose of 54 Gy (stereotactic fractionated radiotherapy).

Results: Hearing after radiotherapy was highly variable: permanent improvement of hearing (3.9 dB in average) was seen in 13 patients (21%). In contrast a hearing loss of more than 40 dB was seen in 3 patients (5%). The average hearing loss, however, was 9 dB for one-time radiation and 18 dB for fractionated radiotherapy.

Vertigo after radiotherapy newly occurred or worsened in 20%, and improved in 35% of the patients.

An incomplete facial paralysis occurred in one patient (1.6%), disappeared completely after 3 months.

Paraesthesias of the trigeminal nerve were reported by 15 patients (24%). They completely dissolved in 11 patients.

These preliminary results indicate that radiotherapy of vestibular schwannomas has good functional results. Hearing could be preserved well and in some cases even improved. No permanent facial paralysis occurred and most trigeminal paraesthesias were transient. Thus, radiotherapy has to be considered as a treatment option in vestibular schwannomas, especially in small tumours and elderly patients.