Skip to main content
SpringerLink
Log in

Long-term quality of life and tumour control following gamma knife radiosurgery for vestibular schwannoma

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Introduction

Gamma knife radiosurgery (GKRS) has for the last decades been an established treatment option for patients with small- or medium-sized vestibular schwannomas (VS), although little data is reported on long-term outcome regarding quality of life (QOL) and tumour control in this patient category. The objective of this study was to investigate long-term QOL and tumour control in GKRS-treated VS patients at our institution.

Methods

Data was reviewed from a consecutive cohort of 128 patients, 62 men and 66 women, diagnosed with VS and treated with GKRS at Karolinska University Hospital between 1997 and 2003. Patients previously treated for VS, patients from abroad, and patients with neurofibromatosis were excluded from the study. Median age at the time of treatment was 66 years (range 23–89), with a median follow-up time of 104 months (range 11–165) and radiological median follow-up of 86 months (range 5–170). Five patients were lost to follow-up.

Results

Data on QOL (EQ-5D score) was obtained in 90 % (98/109) of all cases at the end of follow-up, showing low morbidity and a high QOL with median index of 0.91 (max. score 1.0) in these patients. Tumour control was achieved in 92 % (118/128) of patients after a single GKRS treatment. Ten patients had loss of tumour control, either radiologically seen as growth progression, or due to the need for salvage treatment. Neither pre-treatment growth of the vestibular schwannoma, or a large tumour size (Koos grade 3 & 4) was correlated with a higher degree of treatment failure (p = 0.695 and p = 0.647, respectively). There was no difference in tumour control in young (<60 y/o) vs. elderly (≥60 y/o) patients (p = 0.167).

Conclusion

We report a high QOL and low morbidity at long-term follow-up after GKRS treatment in VS patients. Furthermore, a high tumour control rate was achieved independent of tumour size, patient age or pre-treatment evidence of tumour growth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bakkouri WE, Kania RE, Guichard JP, Lot G, Herman P, Huy PT (2009) Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 110:662–669

    Article  PubMed  Google Scholar 

  2. Battaglia A, Mastrodimos B, Cueva R (2006) Comparison of growth patterns of acoustic neuromas with and without radiosurgery. Otol Neurotol: Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 27:705–712

    Article  Google Scholar 

  3. Breivik CN, Nilsen RM, Myrseth E, Pedersen PH, Varughese JK, Chaudhry AA, Lund-Johansen M (2013) Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 73:48–57

    Article  PubMed  Google Scholar 

  4. Breivik CN, Varughese JK, Wentzel-Larsen T, Vassbotn F, Lund-Johansen M (2012) Conservative management of vestibular schwannoma - A prospective cohort study: treatment, symptoms and quality of life. Neurosurgery 70:1072–1080

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Fuentes S, Arkha Y, Pech-Gourg G, Grisoli F, Dufour H, Regis J (2008) Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery. Prog Neurol Surg 21:79–82

    Article  PubMed  Google Scholar 

  7. Gauden A, Weir P, Hawthorne G, Kaye A (2011) Systematic review of quality of life in the management of vestibular schwannoma. J Clin Neurosci: Off J Neurosurg Soc Australas 18:1573–1584

    Article  Google Scholar 

  8. Greiner W, Weijnen T, Nieuwenhuizen M, Oppe S, Badia X, Busschbach J, Buxton M, Dolan P, Kind P, Krabbe P, Ohinmaa A, Parkin D, Roset M, Sintonen H, Tsuchiya A, de Charro F (2003) A single European currency for EQ-5D health states. Results from a six-country study. Eur J Health Econ 4:222–231

    Article  PubMed  Google Scholar 

  9. Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J (2005) Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 57:257–265, discussion 257-265

    Article  PubMed  Google Scholar 

  10. Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with gamma knife surgery. Journal of neurosurgery 118:557–565

    Article  PubMed  Google Scholar 

  11. Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J (2005) Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up. J Neurosurg 102:10–16

    Article  PubMed  Google Scholar 

  12. Hayhurst C, Zadeh G (2012) Tumor pseudoprogression following radiosurgery for vestibular schwannoma. Neuro Oncol 14:87–92

    Article  PubMed Central  PubMed  Google Scholar 

  13. Jacob A, Robinson LL Jr, Bortman JS, Yu L, Dodson EE, Welling DB (2007) Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope 117:2087–2092

    Article  PubMed  Google Scholar 

  14. Jakola AS, Gulati M, Gulati S, Solheim O (2012) The influence of surgery on quality of life in patients with intracranial meningiomas: a prospective study. J Neuro-Oncol 110:137–144

    Article  Google Scholar 

  15. Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433

    Article  CAS  PubMed  Google Scholar 

  16. Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512

    Article  CAS  PubMed  Google Scholar 

  17. Koos WT, Spetzler RF, Lang J (1993) Coloratlas of Microneurosurgery. Thieme, Stuttgart

    Google Scholar 

  18. Liu D, Xu D, Zhang Z, Zhang Y, Zheng L (2006) Long-term outcomes after gamma knife surgery for vestibular schwannomas: a 10-year experience. J Neurosurg 105(Suppl):149–153

    PubMed  Google Scholar 

  19. Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD (2009) Gamma knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery 65:294–300, discussion 300-291

    Article  PubMed  Google Scholar 

  20. Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D (2005) Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102(Suppl):195–199

    Article  PubMed  Google Scholar 

  21. Maniakas A, Saliba I (2012) Conservative management versus stereotactic radiation for vestibular schwannomas: a meta-analysis of patients with more than 5 years' follow-up. Otol Neurotol: Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 33:230–238

    Article  Google Scholar 

  22. Mindermann T, Schlegel I (2013) Grading of vestibular schwannomas and corresponding tumor volumes: ramifications for radiosurgery. Acta Neurochir (Wien) 155:71–74, discussion 74

    Article  CAS  Google Scholar 

  23. Myrseth E, Moller P, Pedersen PH, Lund-Johansen M (2009) Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 64:654–661, discussion 661-653

    Article  PubMed  Google Scholar 

  24. Myrseth E, Moller P, Wentzel-Larsen T, Goplen F, Lund-Johansen M (2006) Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life. Neurosurgery 59:67–76, discussion 67-76

    Article  PubMed  Google Scholar 

  25. Nagano O, Higuchi Y, Serizawa T, Ono J, Matsuda S, Yamakami I, Saeki N (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109:811–816

    Article  PubMed  Google Scholar 

  26. Niranjan A, Mathieu D, Flickinger JC, Kondziolka D, Lunsford LD (2008) Hearing preservation after intracanalicular vestibular schwannoma radiosurgery. Neurosurgery 63:1054–1062, discussion 1062-1053

    Article  PubMed  Google Scholar 

  27. Pollock BE (2006) Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 58:241–248, discussion 241-248

    Article  PubMed  Google Scholar 

  28. Pollock BE (2008) Vestibular schwannoma management: an evidence-based comparison of stereotactic radiosurgery and microsurgical resection. Prog Neurol Surg 21:222–227

    Article  PubMed  Google Scholar 

  29. Pollock BE, Driscoll CL, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85, discussion 77-85

    Article  PubMed  Google Scholar 

  30. Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanaret M, Peragut JC (2002) Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100

    Article  PubMed  Google Scholar 

  31. Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM (2008) Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg 21:142–151

    Article  PubMed  Google Scholar 

  32. Solheim O, Jakola AS, Gulati S, Johannesen TB (2012) Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg 116:825–834

    Article  PubMed  Google Scholar 

  33. Stangerup SE, Caye-Thomasen P (2012) Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin N Am 45:257–268, vii

    Article  Google Scholar 

  34. Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Regis J (2009) Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 64:289–296, discussion 296

    Article  PubMed  Google Scholar 

  35. Timmer FC, Hanssens PE, van Haren AE, van Overbeeke JJ, Mulder JJ, Cremers CW, Graamans K (2011) Follow-up after gamma knife radiosurgery for vestibular schwannomas: volumetric and axial control rates. Laryngoscope 121:1359–1366

    Article  PubMed  Google Scholar 

  36. van de Langenberg R, Hanssens PE, Verheul JB, van Overbeeke JJ, Nelemans PJ, Dohmen AJ, de Bondt BJ, Stokroos RJ (2011) Management of large vestibular schwannoma. Part II. Primary gamma knife surgery: radiological and clinical aspects. J Neurosurg 115:885–893

    Article  PubMed  Google Scholar 

  37. van Leeuwen BM, Herruer JM, Putter H, Jansen JC, van der Mey AG, Kaptein AA (2013) Validating the penn acoustic neuroma quality of life scale in a sample of Dutch patients recently diagnosed with vestibular schwannoma. Otol Neurotol: Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 34:952–957

    Article  Google Scholar 

  38. van Roijen L, Nijs HG, Avezaat CJ, Karlsson G, Linquist C, Pauw KH, Rutten FF (1997) Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma. Acta Neurochir (Wien) 139:942–948

    Article  Google Scholar 

  39. Wittrup-Jensen KU, Lauridsen J, Gudex C, Pedersen KM (2009) Generation of a Danish TTO value set for EQ-5D health states. Scand J Public Health 37:459–466

    Article  PubMed  Google Scholar 

  40. Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A (2013) What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 3:1–8

    Article  Google Scholar 

  41. Yang I, Sughrue ME, Han SJ, Fang S, Aranda D, Cheung SW, Pitts LH, Parsa AT (2009) Facial nerve preservation after vestibular schwannoma gamma knife radiosurgery. J Neuro-Oncol 93:41–48

    Article  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Karolinska University Hospital, Karolinskavägen, 17176, Stockholm, Sweden

    Theresa Wangerid, Jiri Bartek Jr., Mikael Svensson & Petter Förander

  2. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Theresa Wangerid, Jiri Bartek Jr., Mikael Svensson & Petter Förander

  3. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Jiri Bartek Jr.

Authors
  1. Theresa Wangerid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiri Bartek Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikael Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petter Förander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theresa Wangerid.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wangerid, T., Bartek, J., Svensson, M. et al. Long-term quality of life and tumour control following gamma knife radiosurgery for vestibular schwannoma. Acta Neurochir 156, 389–396 (2014). https://doi.org/10.1007/s00701-013-1924-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1924-5

Keywords

Search

Navigation