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.

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_579879995933
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
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.
Périodique
Acta neurochirurgica
Auteur(s)
Daniel R.T., Tuleasca C., George M., Pralong E., Schiappacasse L., Zeverino M., Maire R., Levivier M.
ISSN
0942-0940 (Electronic)
ISSN-L
0001-6268
Statut éditorial
Publié
Date de publication
07/2017
Peer-reviewed
Oui
Volume
159
Numéro
7
Pages
1197-1211
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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 follow-up after GKRS was 24 months (range 3-60). Following GKRS, there were no new neurological deficits, with facial and hearing functions remaining identical to those after surgery in all patients. Three patients presented with continuous growth after GKRS, were considered failures, and benefited from the same combined approach a second time.
Our data suggest that large VS management, with planned subtotal resection followed by GKRS, might yield an excellent clinical outcome, allowing the normal facial nerve and a high level of cochlear nerve functions to be retained. Our functional results with this approach in large VS are comparable with those obtained with GKRS alone in small- and medium-sized VS. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.

Mots-clé
Adult, Aged, Cochlear Nerve/physiology, Cochlear Nerve/surgery, Facial Nerve/physiology, Facial Nerve/surgery, Female, Hearing, Humans, Male, Middle Aged, Neuroma, Acoustic/surgery, Postoperative Complications/etiology, Postoperative Complications/prevention & control, Radiosurgery/adverse effects, Radiosurgery/methods, Combined approach, Gamma knife, Radiosurgery, Surgery, Vestibular schwannoma
Pubmed
Web of science
Open Access
Oui
Création de la notice
30/05/2017 16:58
Dernière modification de la notice
20/08/2019 14:11
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