Artikel
Local tumor control and clinical symptoms after Gamma Knife Surgery for vestibular schwannomas in a series of over 1100 patients
Suche in Medline nach
Autoren
-
Albertus T. C. J. van Eck
- Gamma Knife Zentrum Krefeld, Krefeld, Germany
-
Gerhard Horstmann
- Gamma Knife Zentrum Krefeld, Krefeld, Germany
-
Eric Jose Suero Molina
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Germany
-
Cristina Sauerland
- Institut für Biostatistik and Klinische Forschung, Universitätsklinikum Münster, Germany
-
Walter Stummer
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Germany
-
Benjamin Brokinkel
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Germany
| Veröffentlicht: | 8. Juni 2016 |
|---|
Gliederung
Text
Objective: To determine predictors of tumor control and side effects of Gamma Knife Surgery (GKS) for Vestibular Schwannomas (VS).
Method: Clinical and radiological data of 1177 patients (median age: 50 years) who underwent GKS for primarily diagnosed (N=987, 86%) and recurrent VS [previous microsurgery (MS), N=164, 14%] were retrospectively analyzed.
Results: Data on facial nerve function and hearing [House&Brackmann (H&B) and modified Gardner Robertson Scale (G&R)], tinnitus, vertigo and 5th nerve symptoms before GKS (median margin dose 13Gy) and at the time of last follow-up were available in 1070 patients (91%). VS volume was known in all patients (median: .77ccm, range .02-35.0) and tumors were classified as T1, T2, T3a, T3b, T4a and T4b in 17%, 39%, 22%, 13%, 8% and 1%. Facial nerve function and hearing were serviceable (H&B and G&R I-II) in 92% (N=1057) and 41% (N=475) of 1148 and 1151 patients, respectively. With a median follow-up of 35 months, tumor volume increased >10% in 189 patients (16%) after a median of 20 months, requiring MS in 37 (3%) and repeated GKS in 41 individuals (4%). Progression occurred in 7 of 17 (41%) and in 182 of 1131 (16%; p=.013) patients with and without Neurofibromatosis and in 65 males (13%) but 124 females (19%, p=.016). Regrowth was independent of tumor volume but more commonly registered in smaller VS according to the Hannover classification (e.g. 13% in T1 vs. 7% in T4b, p=.016). However, Cox regression analyses confirmed none of the included parameters to independently predict tumor progression. Facial nerve function and hearing deteriorated to grades >II in 1% and 13%, respectively, and increasing tinnitus, vertigo, and 5th nerve symptoms were observed in 9%, 10% and 3%. Hydrocephalus and facial spasms occurred in 1% and 4%. Increase of H&B grade was higher after previous MS (3% vs. <.5%, OR: 8.5; p=.010 ) and hearing deteriorated more often after initial GKS (15% vs. 1%; OR: 14.5; p<.001) and in younger patients (OR: .9, p<.001). Vertigo deteriorated more commonly in the elderly (p=.038). Frequency of 5th nerve symptoms increased with tumor volume (OR: 1.1; p=.021) and size (OR: 14.3; p=.013). Hydrocephalus was correlated to increasing tumor size (p=.001), volume (OR: 1.3; p<.001) and age (OR: 1.1; p<.001).
Conclusions: GKS provides safe and sufficient local tumor control especially in smaller VS. Numerous risk factors for tumor progression and side effects were identified.
