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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
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
,
Constantin Tuleasca
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
3   Medical Image Analysis Laboratory (MIAL), Lausanne University Hospital, Lausanne, VauD, Switzerland
4   Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, VauD, Switzerland
,
Alda Rocca
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
,
Mercy George
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
5   Department of Otorhinolaryngology/Head & Neck Surgery, Lausanne University Hospital, Lausanne, VauD, Switzerland
,
Etienne Pralong
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
,
Luis Schiappacasse
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
6   Radiation Oncology Service, Lausanne, VauD, Switzerland
,
Michele Zeverino
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
7   Institute of Radiation Physics, Lausanne University Hospital (CHUV), Lausanne, VauD, Switzerland
,
Raphael Maire
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
5   Department of Otorhinolaryngology/Head & Neck Surgery, Lausanne University Hospital, Lausanne, VauD, Switzerland
,
Mahmoud Messerer
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
,
Marc Levivier
1   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, Lausanne, VauD, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne, Lausanne, VauD, Switzerland
› Author Affiliations
Further Information

Publication History

01 February 2018

11 July 2018

Publication Date:
23 August 2018 (online)

Also available atMedOne
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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