The Role of a Neurootologist in Identification of Post-radiation Complications in Patients with Vestibular Schwannoma Treated with Leksell Gamma Knife


Authors: R. Holý 1;  J. Skutil 2;  M. Navara 1;  P. Praženica 1;  P. Fundová 1;  A. Hahn 2
Authors‘ workplace: ORL klinika 3. LF UK a ÚVN – Vojenská FN Praha 1;  ORL klinika 3. LF UK a FN Královské Vinohrady, Praha 2
Published in: Cesk Slov Neurol N 2013; 76/109(2): 191-196
Category: Short Communication

Overview

Purpose:
The results of audiological-otoneurological tests before treatment of patients with vestibular schwannoma with the Leksell gamma knife were compared with findings after the treatment. The results were assessed in correlation with PC volumetry and brain MRI. Changes to the tumor size were monitored and the treatment effect evaluated. We focused on the detection of complications including deterioration of hearing, tinnitus, vertigo, instability, manifestation of neuropathy n. V, development of paresis n. VII, hyporesorptive hydrocephalus.

Patients and methods:
Between 1999 and 2009, 27 patients were fully neurootologically examined before the treatment and subsequently and repeatedly after the treatment. The follow-up after radiosurgery was 20–132 months, 50 months on average.

Results:
Treatment success rate was 81%; enlargement of the tumor was detected in 5 (19%) cases. Three of the five patients with enlarged tumors were successfully treated with reirradiation, one patient was treated using microsurgery (postoperative complications occurred), and one patient was successfully treated with corticosteroids. We detected one patient with hyporesorptive hydrocefalus progression. Total number of complications detected made up 22%.

Conclusions:
Monitoring of the otoneurological profile contributed to detection of some complications associated with the treatment with the Leksell gamma knife. Detection of complications is significant for the patient’s prognosis. The results testify to the significance of involving a neurootologist in the treatment and monitoring of patients with vestibular schwannoma.

Key words:
vestibular schwannoma – radiosurgery – gamma knife


Sources

1. Liščák R. Vestibulární schwannom. In: Liščák R et al. Radiochirugie gama nožem, principy a neurochirurgické aplikace. Praha: Grada Publishing 2009: 93–108.

2. Sartor K. MR Imaging of the skull and brain: a cor­relative text atlas. 1st ed. New York (NY): Springer Verlag 1992: 354–366.

3. Bednář B et al. Patologie I. 1st ed. Praha: Avicenum 1982: 415–416.

4. Hahn A, Dutka J. Comprehensive diagnosis of tumours of the statoacoustic nerve. Cesk Otolaryngol 1989; 38(2): 65–69.

5. Hahn A. Neurootologische Befunde bei Patienten mit Akustikusneurinomen [dissertation]. Würzburg (Germany): die Bayerische Julius-Maximilians Univ 1993.

6. Hahn A, Fundova P, Schneider D. Audiovestibular findings prior to and after acoustic neuroma surgery. Int Tinnitus J 2000; 6(1): 67–69.

7. Molčan M. Vertigo – základy diagnostiky a liečby. 1st ed. Košice: Elfa 2002: 106–109.

8. Pichanič M. Klinická otoneurológia. 1st ed. Martin: Osveta 1992: 235–254.

9. Liščák R, Vladyka V, Urgošík D, Šimonová G, Novotný J jr, Bareš K. Neurinom akustiku a jeho léčba Leksellovým gama nožem. Otorinolaryngol Foniat 1998; 47: 103–105.

10. Liščák R, Novotný J jr, Vladyka V. Rizikové faktory radiochirurgické léčby neurinomu akustiku pomocí gama nože. Cesk Slov Neurol N 1999; 62/95(5): 277–283.

11. Liscak R, Vladyka V, Simonová G, Novotný J. Radiosurgical treatment of meningioma with the Leksell gamma knife. Cas Lek Cesk 1995; 134(17): 534–538.

12. Šmilauer T, Kluh J, Zvěřina E, Betka J. Přínos BERA k diagnostice neurinomu akustiku. Otorinolaryngol Foniat 2001; 50: 99–102.

13. Holy R, Navara M, Dosel P, Fundova P, Prazenica P, Hahn A. Hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss (ISSNHL) in association with combined treatment. Undersea Hyperbar Med 2011; 38(2): 137–142.

14. ÚVN (CZ). Směrnice pro vyšetřování vestibulární činnosti. Praha: Ústřední vojenská nemocnice v Praze ORL oddělení 1985: 1–44.

15. Koval J, Molcan M, Bowdler AD, Sterkers JM. Retrosigmoid transmeatal approach: an anatomic study of an approach used for preservation of hearing in acoustic neuroma surgery and vestibular neurotomy. Skull Base Surg 1993; 3(1): 16–21.

16. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resection. Neurosurgery 1997; 40(2): 248–262.

17. Tos M, Thomsen J, Harmsen A. Results of trans­labyrinthine removal of 300 acoustic neuromas related to tumour size. Acta Otolaryngol Suppl 1988; 452: 38–51.

18. Skrivan J, Zverina E, Betka J, Kluh J, Kraus J. Our surgical experience with large vestibular schwannomas. Otolaryngol Pol 2004; 58(1): 69–72.

19. Zverina E. Acoustic neuroma – vestibular schwannoma – personal experience of up-to-date management. Cas Lek Cesk 2010; 149(6): 269–276.

20. Urgošík D, Živný B, Zvěřina E, Fusek I, Stejskal L, Plas J. Elektrofyziologické sledování funkce n. VII. při operacích neurinomu n. VIII. Cesk Slov Neurol N 1994; 57/90(1): 17–21.

21. Wowra B, Horstmann GA, Cibis R, Czempiel H. Profile of ambulatory radiosurgery with the gamma knife system. 2: Report of clinical experiences. Radiologe 1997; 37(12): 1003–1015.

22. Talfer S, Dutertre G, Conessa C, Desgeorges M, Poncet JL. Surgical treatment of large vestibular schwannomas (stages III and IV). Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127(2): 63–69.

23. Leksell L. The stereotactic method and radiosurgery of the brain. Acta Chir Scand 1951; 102(4): 316–319.

24. Leksell L. Cerebral radiosurgery. I. Gammathalamotomy in two cases of intractable pain. Acta Chir Scand 1968; 134(8): 585–595.

25. Leksell L. A note on the treatment of acoustic tumors. Acta Chir Scand 1971; 137(8): 763–765.

26. 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.

27. Nakaya K, Niranjan A, Kondziolka D, Kano H, Khan AA, Nettel B et al. Gamma knife radiosurgery for benign tumors with symptoms from brainstem compression. Int J Radiat Oncol Biol Phys 2010; 77(4): 988–995.

28. Conley GS, Hirsch BE. Stereotactic radiation treatment of vestibular schwannoma: indications, limita­tions, and outcomes. Curr Opin Otolaryngol Head Neck Surg 2010; 18(5): 351–356.

29. Battista RA. Gamma knife radiosurgery for vestibular schwannoma. Otolaryngol Clin North Am 2009; 42(4): 635–654.

30. Bertalanffy A, Dietrich W, Aichholzer M, Brix R, Ertl A, Heimberger K et al. Gamma knife radiosurgery of acoustic neurinomas. Acta Neurochir 2001; 143(7): 689–695.

31. Fukuoka S, Takanashi M, Hojyo A, Konishi M, Tanaka C, Nakamura H. Gamma knife radiosurgery for vestibular schwannomas. Prog Neurol Surg 2009; 22: 45–62.

32. Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS. Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 2001; 49(6): 1297–1306.

33. Régis J, Delsanti C, Roche PH, Thomassin JM, Pellet W. Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature. Neurochirurgie 2004; 50(2–3): 301–311.

34. 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.

35. Liscak R, Vladyka V, Urgosik D, Simonova G, Vymazal J. Repeated treatment of vestibular schwannomas after gamma knife radiosurgery. Acta Neurochir (Wien) 2009; 151(4): 317–324.

36. Kliesch S, Vogelgesang S, Benecke R, Horstmann GA, Schroeder HW. Malignant brain oedema after radiosurgery of a medium-sized vestibular schwannoma. Cen Eur Neurosurg 2010; 71(2): 88–91.

37. Hahn A, Bares K, Holcat M. Diagnosis of tumors of the statoacoustic nerve. Cesk Otolaryngol 1985; 34(4): 236–239.

38. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93(2): 146–147.

39. Havlík R, Kollár A, Lejska M. Návrh diagnostického algoritmu při podezření na nádor VIII. hlavového nervu. Otorinolaryngol a Foniat 2000; 49: 101–104.

40. Franzin A, Spatola G, Serra C, Picozzi P, Medone M, Milani D et al. Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas. Neurosurg Focus 2009; 27(6): E3.

41. Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988; 97(1): 55–66.

42. Kim CH, Chung KW, Kong DS, Nam DH, Park K, Lee JI et al. Prognostic factors of hearing preservation after gamma knife radiosurgery for vestibular schwannoma. J Clin Neurosci 2010; 17(2): 214–218.

43. Neuhas O, Saleh A, van Oosterhout A, Siebler M. Cerebellar infarction after gamma knife radiosurgery of a vestibular schwannoma. Neurology 2007; 68(8): 590.

44. Niranjan A, Mathieu D, Flickinger JC, Kondziolka D, Lunsford LD. Hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Neurosurgery 2008; 63(6): 1054–1062.

45. Norén G. Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 1998; 70 (Suppl 1): 65–73.

46. Lasak JM, Klish D, Kryzer TC, Hearn C, Gorecki JP, Rine GP. Gamma knife radiosurgery for vestibular schwannoma: early hearing outcomes and evaluation of the cochlear dose. Otol Neurotol 2008; 29(8): 1179–1186.

47. Osborn AG. Diagnostic Neuroradiology. 1st ed. St. Louis (MO): Mosby 1994: 626–630.

48. Chung WY, Liu KD, Shiau CY, Wu HM, Wang LW, Guo WY et al. Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 2005; 102 (Suppl): 87–96.

49. Iwai Y, Yamanaka K, Shiotani M, Uyama T. Radio­surgery for acoustic neuromas: results of low-dose treatment. J Neurosurgery 2003; 53(2): 283–288.

50. Gabert K, Régis J, Delsanti C, Roche PH, Facon F, Tamura M et al. Preserving hearing function after Gamma Knife radiosurgery for unilateral vestibular schwannoma. Neurochirurgie 2004; 50(2–3): 350–357.

51. Massager N, Nissim O, Delbrouck C, Delpierre I, Devriendt D, Desmedt F et al. Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 2007; 107(4): 733–739.

52. Mohammed TA, Ahuja MS, Ju SS, Thomas J. Normal pressure hydrocephalus after gamma knife radio­surgery for vestibular schwannoma. J Postgrad Med 2010; 56(3): 213–215.

53. Jeon CJ, Kong DS, Nam DH, Lee JI, Park K, Kim JH. Communicating hydrocephalus associated with surgery or radiosurgery for vestibular schwannoma. J Clin Neurosci 2010; 17(7): 862–864.

54. Pirouzmand F, Tator C, Rutka F. Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 2001; 48(6): 1246–1254.

55. Roche PH, Khalil M, Soumare O, Régis J. Hydrocephalus and vestibular schwannomas: considerations about the impact of gamma knife radiosurgery. Prog Neurol Surg 2008; 21: 200–206.

56. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka DS. Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors. Arch Neurol 1995; 52(1): 73–79.

57. Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD. Results of acoustic neuroma radiosurgery: an analysis of 5 years‘ experience using current methods. J Neurosurg 2001; 94(1): 1–6.

58. Pollack AG, Marymont MH, Kalapurakal JA, Kepka A, Sathiaseelan V, Chandler JP. Acute neurological complications following gamma knife surgery for vestibular schwannoma. Case report. J Neurosurg 2005; 103(3): 546–551.

59. Peker S, Ozduman K, Kilic T, Pamir MN. Relief of hemifacial spasm after radiosurgery for intracanalicular vestibular schwannoma. Minim Invasive Neurosurg 2004; 47(4): 235–237.

60. Yang I, Sughrue ME, Han SJ, Fang S, Aranda D, Cheung SW et al. Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery. J Neurooncol 2009; 93(1): 41–48.

61. Sakamoto GT, Blevins N, Gibbs IC. Cyberknife radiotherapy for vestibular schwannoma. Otolaryngol Clin North Am 2009; 42(4): 665–675.

62. Betka J, Zvěřina E, Lisý J, Chovanec M, Kluh J, Kraus J. Vestibulární schwannom. Otorinolaryngol a Foniat 2008; 57: 221–225.

63. Sameš M, Vachata P. Historie a současnost chirurgie baze lební. Cesk Slov Neurol N 2003; 66/99(5): 315–322.

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Paediatric neurology Neurosurgery Neurology

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