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22.12.2022 | Original Article - Tumor - Schwannoma

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

verfasst von: Chloe Dumot, Stylianos Pikis, Georgios Mantziaris, Zhiyuan Xu, Sam Dayawansa, Rithika Kormath Anand, Ahmed M. Nabeel, Darrah Sheehan, Kimball Sheehan, Wael A. Reda, Sameh R. Tawadros, Khaled Abdel Karim, Amr M. N. El-Shehaby, Reem M. Emad Eldin, Selcuk Peker, Yavuz Samanci, Tehila Kaisman-Elbaz, Herwin Speckter, Wenceslao Hernández, Julio Isidor, Manjul Tripathi, Renu Madan, Brad E. Zacharia, Lekhaj C. Daggubati, Nuria Martínez Moreno, Roberto Martínez Álvarez, Anne-Marie Langlois, David Mathieu, Christopher P. Deibert, Vivek R. Sudhakar, Christopher P. Cifarelli, Denisse Arteaga Icaza, Daniel T. Cifarelli, Zhishuo Wei, Ajay Niranjan, Gene H. Barnett, L. Dade Lunsford, Greg N. Bowden, Jason P. Sheehan

Erschienen in: Acta Neurochirurgica | Ausgabe 1/2023

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Abstract

Background

Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old.

Method

This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up.

Results

One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients.

Conclusion

SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.

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Titel: Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study
verfasst von: Chloe Dumot
Stylianos Pikis
Georgios Mantziaris
Zhiyuan Xu
Sam Dayawansa
Rithika Kormath Anand
Ahmed M. Nabeel
Darrah Sheehan
Kimball Sheehan
Wael A. Reda
Sameh R. Tawadros
Khaled Abdel Karim
Amr M. N. El-Shehaby
Reem M. Emad Eldin
Selcuk Peker
Yavuz Samanci
Tehila Kaisman-Elbaz
Herwin Speckter
Wenceslao Hernández
Julio Isidor
Manjul Tripathi
Renu Madan
Brad E. Zacharia
Lekhaj C. Daggubati
Nuria Martínez Moreno
Roberto Martínez Álvarez
Anne-Marie Langlois
David Mathieu
Christopher P. Deibert
Vivek R. Sudhakar
Christopher P. Cifarelli
Denisse Arteaga Icaza
Daniel T. Cifarelli
Zhishuo Wei
Ajay Niranjan
Gene H. Barnett
L. Dade Lunsford
Greg N. Bowden
Jason P. Sheehan
Publikationsdatum: 22.12.2022
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 1/2023
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-022-05454-w

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