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Acta Neurochir Suppl. 2013;116:19-23. doi: 10.1007/978-3-7091-1376-9_4.

Whether gamma knife radiosurgery is really necessary for treatment of patients with vestibular schwannomas.

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1
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. thori@moriyamaikai.or.jp

Abstract

The present study was directed at establishing the role of Gamma Knife radiosurgery (GKS) in the management of vestibular schwannomas (VSs), particularly those that are large. We analyzed a consecutive series of 222 tumors operated on by a single neurosurgeon (T. Hori) at Tottori University (1981-1998) and Tokyo Women's Medical University (1998-2011). The surgical strategy for sporadic unilateral VSs was typically total or nearly total tumor removal with facial nerve preservation, whereas in some cases of neurofibromatosis type 2 intentional subtotal resection was performed. In all, 15 patients (8.6 %) in the series underwent GKS before (4 cases), after (9 cases), or before and after (2 cases) tumor removal. Overall, 211 patients (95 %) were cured by microsurgery alone. Of note, six patients underwent primary radiosurgery but were operated later on for regrowth of the neoplasm, and in four of them near-total resection led to good long-term tumor control. GKS was required in only 5 % of cases for management of residual VS or, more frequently, its regrowth. Radiosurgery resulted in volume reduction in one-third of these tumors. In other cases it stabilized the lesion, preventing further progression. Thus, GKS is considered a reasonable management option for residual or regrowing small VSs to obtain maximum tumor growth control after initially attempting complete surgical removal.

PMID:
23417454
DOI:
10.1007/978-3-7091-1376-9_4
[Indexed for MEDLINE]
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