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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Long term follow-up of clinical outcome and quality of life in patients with vestibular schwannoma treated with gamma knife: A single center study of 392 patients

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  • Christian Blume - Uniklinik Aachen, Klinik für Neurochirurgie, RWTH, Aachen, Deutschland
  • Hans Clusmann - Uniklinik Aachen, Klinik für Neurochirurgie, RWTH, Aachen, Deutschland
  • Magdalena Burkhardt - Uniklinik Aachen, Klinik für Neurochirurgie, RWTH, Aachen, Deutschland
  • Katrin Sakreida - Uniklinik Aachen, Klinik für Neurochirurgie, RWTH, Aachen, Deutschland
  • Beate Huffmann - Uniklinik Aachen, Klinik für Neurochirurgie, RWTH, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.13.05

doi: 10.3205/17dgnc251, urn:nbn:de:0183-17dgnc2519

Published: June 9, 2017

© 2017 Blume et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To evaluate long term follow-up of clinical outcome and quality of life (QL) of patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery via Gamma Knife (GK).

Methods: Patients with small or medium sized VS, treated with GK between 1998 and 2012 were analyzed retrospectively. Baseline clinical parameters, imaging data and neurological status were recorded before GK treatment, 3 and 6 months after treatment and from the third year once a year. QL was assessed via questionnaires (SF-36, Glasgow Benefit Inventory (GBI), House and Brackmann Grade (H&B Grade). Overall, LQ assessment was at maximum 18 years after treatment.

Results: 392 patients were included (193 female, mean age 56 years). 69 patients underwent surgical resection before GK, 7 patients after GK treatment because of recurrence. Mean tumor volume was 1.89 cm3. Mean treatment dose was 13 Gy. In follow-up examinations tumor control rate was 98%. 50 % of 102 patients with audiometric testing after treatment showed a deterioration of at least one GR Class, 47 % had no change, and 3 % improved. Concerning the facial nerve no patient developed persistent palsy, two patients presented with transient palsy, and four with transient facial spasm. Trigeminal dysesthesia after treatment was transient in 15 patients (4 %), six patients (2 %) improved, one patient presented a new persistent deficit. During the clinical course, dizziness was constantly reduced to 15 % as well as tinnitus to 26 %. At a mean of 136 months after GK treatment, QL questionnaires were send to 273 contactable patients (67 %), 123 (45 %) were returned completed. The physical health component summary score of the SF-36 was slightly above the norm (mean = 53; 47–48 normal German population), while the mental health component summary score met the standard (mean = 47; 48–51 normal German population). Significant differences were observed in the GBI overall score comparing female (mean = 10.8) and male (mean = 1.2) patients (p = 0.008).

Conclusion: GK is a safe and effective treatment option for small- and medium sized VS as proved by long term follow-up clinical and LQ assessment. We found a high rate of tumor control and low morbidity. Our data showed no clinical relevant deterioration in terms of LQ caused by GK treatment.