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

Authors

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

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

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