Preserving normal facial nerve function and improving hearing outcome in large vestibular schwannomas with a combined approach: planned subtotal resection followed by gamma knife radiosurgery

Acta neurochirurgica
Roy Thomas DanielMarc Levivier

Abstract

To perform planned subtotal resection followed by gamma knife surgery (GKRS) in a series of patients with large vestibular schwannoma (VS), aiming at an optimal functional outcome for facial and cochlear nerves. Patient characteristics, surgical and dosimetric features, and outcome were collected prospectively at the time of treatment and during the follow-up. A consecutive series of 32 patients was treated between July 2010 and June 2016. Mean follow-up after surgery was 29 months (median 24, range 4-78). Mean presurgical tumor volume was 12.5 cm3 (range 1.47-34.9). Postoperative status showed normal facial nerve function (House-Brackmann I) in all patients. In a subgroup of 17 patients with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 16 (94.1%) retained serviceable hearing. Among them, 13 had normal hearing (Gardner-Robertson class 1) before surgery, and 10 (76.9%) retained normal hearing after surgery. Mean duration between surgery and GKRS was 6.3 months (range 3.8-13.9). Mean tumor volume at GKRS was 3.5 cm3 (range 0.5-12.8), corresponding to mean residual volume of 29.4% (range 6-46.7) of the preoperative volume. Mean marginal dose was 12 Gy (range 11-12). Mean fol...Continue Reading

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Citations

Oct 13, 2017·Acta neurochirurgica·Iulia Peciu-FlorianuMarc Levivier
Sep 26, 2017·Neurosurgery·Constantin TuleascaMarc Levivier
Sep 11, 2019·Neuro-oncology·Roland GoldbrunnerJoerg-Christian Tonn
Apr 25, 2020·Operative Neurosurgery·Julia R SchneiderAmir R Dehdashti
Jul 7, 2020·Laryngo- rhino- otologie·Ali HaratiThomas Deitmer
Feb 23, 2019·Acta neurochirurgica·Constantin TuleascaMarc Levivier
Nov 13, 2019·Reviews on Recent Clinical Trials·Vasileios TzikoulisMaria Tolia
Apr 5, 2020·Cancers·Longping YaoKoos Hovinga
Apr 29, 2019·Journal of the Neurological Sciences·Constantin TuleascaMarc Levivier
Jul 22, 2021·The New England Journal of Medicine·Matthew L Carlson, Michael J Link
Dec 3, 2021·The Laryngoscope·Katherine P WalleriusMatthew L Carlson

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Methods Mentioned

BETA
surgical resections
surgical resection
dissection

Software Mentioned

Stata
Leksell GammaPlan®
GraphPad Prism

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