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Neurochirurgie. 2004 Jun;50(2-3 Pt 2):301-11.

[Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature].

[Article in French]

Author information

  • 1Groupe d'Otoneurochirurgie, Hôpital Universitaire de La Timone, Marseille. jregis@ap-hm.fr

Abstract

RATIONALE:

To evaluate the functional results of Gamma Knife surgery of vestibular schwannomas relying on a large and prospective series of consecutive cases.

MATERIAL AND METHOD:

The first 1000 patients with cerebello-pontine angle schwannomas were consecutively treated by Gamma Knife in Marseille Timone University Hospital between July 1992 and March 2001. Patients without NF2 and or clinico-radiological arguments in favor of a facial origin accounted for a population of 927 patients (414 males, for 513 females) including 843 treated in first intention. In this series the Koos classification was: stage I 77 patients, stage II 520 patients, stage III 287 patients and stage IV 42 patients. The average Volume was 12.7mm3. Haring was usefull (Gardner and Robertson) before radiosurgery in 47% of the patients (subnormal in 20.3%).

RESULTS:

Tumor control at last follow-up was 97%. Globally, a clinical trigeminal injury was observed in 0.6% of the patients and a facial palsy in 1.3%. There was clearly a decrease of the incidence of neuropathies with time; no facial palsy being reported among the last 258 patients. The rate of functional hearing preservation (Gardner) for patients initially in class I was 77.8% (47.6% for class II) at 3 Years. This rate of functional preservation reached 95% among patients with tinnitus as a first symptom.

CONCLUSION:

Today, strong evidence surports the superiority of Gamma Knife surgery in term of functional perservation and equal efficacy compared with microsurgical removal. Consequently, radiosurgery must be preferred as a first intention choice for young patients with few symptoms presenting with a small to middle size vestibular schwannomas (Koos I-III).

PMID:
15179283
[PubMed - indexed for MEDLINE]
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