The Changing Paradigm for the Surgical Treatment of Large Vestibular Schwannomas

Roy Thomas Daniel; Constantin Tuleasca; Alda Rocca; Mercy George; Etienne Pralong; Luis Schiappacasse; Michele Zeverino; Raphael Maire; Mahmoud Messerer; Marc Levivier

doi:10.1055/s-0038-1668540

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2018; 79(S 04): S362-S370
DOI: 10.1055/s-0038-1668540

WFSBS 2016

Georg Thieme Verlag KG Stuttgart · New York

The Changing Paradigm for the Surgical Treatment of Large Vestibular Schwannomas

Roy Thomas Daniel

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

,

Constantin Tuleasca

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

³Medical Image Analysis Laboratory (MIAL), Lausanne University Hospital, Lausanne, VauD, Switzerland

⁴Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, VauD, Switzerland

,

Alda Rocca

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

,

Mercy George

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

⁵Department of Otorhinolaryngology/Head & Neck Surgery, Lausanne University Hospital, Lausanne, VauD, Switzerland

,

Etienne Pralong

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

,

Luis Schiappacasse

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

⁶Radiation Oncology Service, Lausanne, VauD, Switzerland

,

Michele Zeverino

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

⁷Institute of Radiation Physics, Lausanne University Hospital (CHUV), Lausanne, VauD, Switzerland

,

Raphael Maire

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

⁵Department of Otorhinolaryngology/Head & Neck Surgery, Lausanne University Hospital, Lausanne, VauD, Switzerland

,

Mahmoud Messerer

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

,

Marc Levivier

¹Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland

²Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland

› Author Affiliations

Abstract

Objective Planned subtotal resection followed by Gamma Knife surgery (GKS) in patients with large vestibular schwannoma (VS) has emerged during the past decade, with the aim of a better functional outcome for facial and cochlear function.

Methods We prospectively collected patient data, surgical, and dosimetric parameters of a consecutive series of patients treated by this method at Lausanne University Hospital during the past 8 years.

Results A consecutive series of 47 patients were treated between July 2010 and January 2018. The mean follow-up after surgery was 37.5 months (median: 36, range: 0.5–96). Mean presurgical tumor volume was 11.8 mL (1.47–34.9). Postoperative status showed normal facial nerve function (House–Brackmann I) in all patients. In a subgroup of 28 patients, with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 26 (92.8%) retained serviceable hearing. Nineteen had good or excellent hearing (Gardner–Robertson class 1) before surgery, and 16 (84.2%) retained it after surgery. Mean duration between surgery and GKS was 6 months (median: 5, range: 3–13.9). Mean residual volume as compared with the preoperative one at GKS was 31%. Mean marginal dose was 12 Gy (11–12). Mean follow-up after GKS was 34.4 months (6–84).

Conclusion Our data show excellent results in large VS management with a combined approach of microsurgical subtotal resection and GKS on the residual tumor, with regard to the functional outcome and tumor control. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.

Keywords

combined approach - vestibular schwannoma - surgery - radiosurgery - Gamma Knife

Full Text

References

References
1 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
2 Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988; 97 (01) 55-66
3 Koos WT, Spetzler RF, Pendl G, Perneczky A, Lang J. Color Atlas of Microsurgery. Stuttgart, Germany: Georg Thieme Verlag; 1985
4 Hayashi M, Ochiai T, Nakaya K. , et al. Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 2006; 105 (Suppl): 5-11
5 Massager N, Nissim O, Delbrouck C. , et al. Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 2007; 107 (04) 733-739
6 Régis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM. Hearing preservation in patients with unilateral vestibular schwannoma after Gamma Knife surgery. Prog Neurol Surg 2008; 21: 142-151
7 Tuleasca C, George M, Faouzi M. , et al. Acute clinical adverse radiation effects after Gamma Knife surgery for vestibular schwannomas. J Neurosurg 2016; 125 (Suppl. 01) 73-82
8 Mindermann T, Schlegel I. How to distinguish tumor growth from transient expansion of vestibular schwannomas following Gamma Knife radiosurgery. Acta Neurochir (Wien) 2014; 156 (06) 1121-1123
9 Regis J, Delsanti C, Roche PH. Editorial: vestibular schwannoma radiosurgery: progression or pseudoprogression?. J Neurosurg 2017; 127 (02) 374-379
10 Nagano O, Higuchi Y, Serizawa T. , et al. Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 2008; 109 (05) 811-816
11 Kondziolka D, Mousavi SH, Kano H, Flickinger JC, Lunsford LD. The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?. Neurosurg Focus 2012; 33 (03) E8
12 Pollock BE, Lunsford LD, Kondziolka D. , et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 1995; 36 (01) 215-224 , discussion 224–229
13 Régis J, Pellet W, Delsanti C. , et al. Functional outcome after Gamma Knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 2002; 97 (05) 1091-1100
14 Myrseth E, Møller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M. Vestibular schwannomas: clinical results and quality of life after microsurgery or Gamma Knife radiosurgery. Neurosurgery 2005; 56 (05) 927-935 , discussion 927–935
15 Myrseth E, Møller P, Pedersen PH, Lund-Johansen M. Vestibular schwannoma: surgery or Gamma Knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 2009; 64 (04) 654-661 , discussion 661–663
16 Pollock BE, Driscoll CL, Foote RL. , et al. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 2006; 59 (01) 77-85 , discussion 77–85
17 Régis J, Carron R, Park MC. , et al. Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 2010; 113 (Suppl): 105-111
18 Golfinos JG, Hill TC, Rokosh R. , et al. A matched cohort comparison of clinical outcomes following microsurgical resection or stereotactic radiosurgery for patients with small- and medium-sized vestibular schwannomas. J Neurosurg 2016; 125 (06) 1472-1482
19 Yang HC, Kano H, Awan NR. , et al. Gamma Knife radiosurgery for larger-volume vestibular schwannomas: clinical article. J Neurosurg 2013; 119 (Suppl): 801-807
20 Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 2003; 59 (04) 283-289 , discussion 289–291
21 Yang SY, Kim DG, Chung HT, Park SH, Paek SH, Jung HW. Evaluation of tumour response after Gamma Knife radiosurgery for residual vestibular schwannomas based on MRI morphological features. J Neurol Neurosurg Psychiatry 2008; 79 (04) 431-436
22 van de Langenberg R, Hanssens PE, van Overbeeke JJ. , et al. Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 2011; 115 (05) 875-884
23 Pan HC, Sheehan J, Sheu ML, Chiu WT, Yang DY. Intracapsular decompression or radical resection followed by Gamma Knife surgery for patients harboring a large vestibular schwannoma. J Neurosurg 2012; 117 (Suppl): 69-77
24 Iwai Y, Ishibashi K, Watanabe Y, Uemura G, Yamanaka K. Functional preservation after planned partial resection followed by Gamma Knife radiosurgery for large vestibular schwannomas. World Neurosurg 2015; 84 (02) 292-300
25 Radwan H, Eisenberg MB, Sandberg Knisely JP, Ghaly MM, Schulder M. Outcomes in patients with vestibular schwannoma after subtotal resection and adjuvant radiosurgery. Stereotact Funct Neurosurg 2016; 94 (04) 216-224
26 Daniel RT, Tuleasca C, George M. , et al. 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 Neurochir (Wien) 2017; 159 (07) 1197-1211
27 Lownie SP, Drake CG. Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients. J Neurosurg 1991; 74 (03) 422-425
28 Park CK, Jung HW, Kim JE, Son YJ, Paek SH, Kim DG. Therapeutic strategy for large vestibular schwannomas. J Neurooncol 2006; 77 (02) 167-171
29 Fuentes S, Arkha Y, Pech-Gourg G, Grisoli F, Dufour H, Régis J. Management of large vestibular schwannomas by combined surgical resection and Gamma Knife radiosurgery. Prog Neurol Surg 2008; 21: 79-82
30 Jung S, Kang SS, Kim TS. , et al. Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas. Surg Neurol 2000; 53 (04) 370-377 , discussion 377–378
31 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112 (04) 860-867
32 Wiet RJ, Mamikoglu B, Odom L, Hoistad DL. Long-term results of the first 500 cases of acoustic neuroma surgery. Otolaryngol Head Neck Surg 2001; 124 (06) 645-651
33 Briggs RJ, Luxford WM, Atkins Jr JS, Hitselberger WE. Translabyrinthine removal of large acoustic neuromas. Neurosurgery 1994; 34 (05) 785-790 , discussion 790–791
34 Mamikoglu B, Wiet RJ, Esquivel CR. Translabyrinthine approach for the management of large and giant vestibular schwannomas. Otol Neurotol 2002; 23 (02) 224-227
35 Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006; 105 (04) 527-535
36 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21 , discussion 21–23
37 Zhang X, Fei Z, Chen YJ. , et al. Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach. J Clin Neurosci 2005; 12 (04) 405-408
38 van de Langenberg R, de Bondt BJ, Nelemans PJ, Dohmen AJ, Baumert BG, Stokroos RJ. Predictors of volumetric growth and auditory deterioration in vestibular schwannomas followed in a wait and scan policy. Otol Neurotol 2011; 32 (02) 338-344
39 Fischer G, Fischer C. [Preservation of hearing in acoustic surgery]. Bull Mem Acad R Med Belg 1995; 150 (10-11): 420-427 , discussion 427–429
40 Fischer G, Fischer C, Rémond J. Hearing preservation in acoustic neurinoma surgery. J Neurosurg 1992; 76 (06) 910-917
41 Fischer G, Morgon A, Fischer C. , et al. [Complete excision of acoustic neurinoma. Preservation of the facial nerve and hearing]. Neurochirurgie 1987; 33 (03) 169-183
42 Hecht CS, Honrubia VF, Wiet RJ, Sims HS. Hearing preservation after acoustic neuroma resection with tumor size used as a clinical prognosticator. Laryngoscope 1997; 107 (08) 1122-1126
43 Wanibuchi M, Fukushima T, McElveen Jr JT, Friedman AH. Hearing preservation in surgery for large vestibular schwannomas. J Neurosurg 2009; 111 (04) 845-854
44 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
45 Chung WY, Liu KD, Shiau CY. , et al. Gamma Knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 2005; 102 (Suppl): 87-96
46 Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J. Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 2005; 57 (02) 257-265 , discussion 257–265
47 Kano H, Kondziolka D, Khan A, Flickinger JC, Lunsford LD. Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 2009; 111 (04) 863-873
48 Liu D, Xu D, Zhang Z, Zhang Y, Zheng L. Long-term outcomes after Gamma Knife surgery for vestibular schwannomas: a 10-year experience. J Neurosurg 2006; 105 (Suppl): 149-153
49 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102 (Suppl): 195-199
50 Niranjan A, Mathieu D, Flickinger JC, Kondziolka D, Lunsford LD. Hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Neurosurgery 2008; 63 (06) 1054-1062 , discussion 1062–1063
51 van Eck AT, Horstmann GA. Increased preservation of functional hearing after Gamma Knife surgery for vestibular schwannoma. J Neurosurg 2005; 102 (Suppl): 204-206
52 Wowra B, Muacevic A, Jess-Hempen A, Hempel JM, Müller-Schunk S, Tonn JC. Outpatient Gamma Knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience. J Neurosurg 2005; 102 (Suppl): 114-118
53 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
54 Ramina R, Coelho Neto M, Bordignon KC, Mattei T, Clemente R, Pires Aguiar PH. Treatment of large and giant residual and recurrent vestibular schwannomas. Skull Base 2007; 17 (02) 109-117
55 Kameyama S, Tanaka R, Honda Y, Hasegawa A, Yamazaki H, Kawaguchi T. The long-term growth rate of residual acoustic neurinomas. Acta Neurochir (Wien) 1994; 129 (3-4): 127-130
56 Kameyama S, Tanaka R, Kawaguchi T, Honda Y, Yamazaki H, Hasegawa A. Long-term follow-up of the residual intracanalicular tumours after subtotal removal of acoustic neurinomas. Acta Neurochir (Wien) 1996; 138 (02) 206-209
57 Godefroy WP, van der Mey AG, de Bruine FT, Hoekstra ER, Malessy MJ. Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol 2009; 30 (05) 629-634
58 Régis J, Carron R, Delsanti C. , et al. Radiosurgery for vestibular schwannomas. Neurosurg Clin N Am 2013; 24 (04) 521-530
59 Tsao MN, Sahgal A, Xu W. , et al. Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. J Radiosurg SBRT 2017; 5 (01) 5-24
60 Starnoni D, Daniel RT, Tuleasca C, George M, Levivier M, Messerer M. Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach. Neurosurg Focus 2018; 44 (03) E4