Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Chloe Dumot^{1

2}, Stylianos Pikis¹, Georgios Mantziaris¹, Zhiyuan Xu¹, Sam Dayawansa¹, Rithika Kormath Anand¹, Ahmed M Nabeel^{3

4}, Darrah Sheehan¹, Kimball Sheehan¹, Wael A Reda^{3

5}, Sameh R Tawadros^{3

5}, Khaled Abdel Karim^{3

5}, Amr M N El-Shehaby^{3

5}, Reem M Emad Eldin^{3

6}, Selcuk Peker⁷, Yavuz Samanci⁷, Tehila Kaisman-Elbaz⁸, Herwin Speckter⁹, Wenceslao Hernández⁹, Julio Isidor⁹, Manjul Tripathi¹⁰, Renu Madan¹⁰, Brad E Zacharia¹¹, Lekhaj C Daggubati¹¹, Nuria Martínez Moreno¹¹, Roberto Martínez Álvarez¹², Anne-Marie Langlois¹³, David Mathieu¹³, Christopher P Deibert¹⁴, Vivek R Sudhakar¹⁵, Christopher P Cifarelli¹⁵, Denisse Arteaga Icaza¹⁵, Daniel T Cifarelli¹⁵, Zhishuo Wei¹⁶, Ajay Niranjan¹⁶, Gene H Barnett⁸, L Dade Lunsford¹⁶, Greg N Bowden¹⁷, Jason P Sheehan¹⁸

Affiliations

¹ Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.
² Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France.
³ Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.
⁴ Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt.
⁵ Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt.
⁶ Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
⁷ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
⁸ Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
⁹ Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic.
¹⁰ Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹¹ Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA.
¹² Department of Radiosurgery, Rúber International Hospital, Madrid, Spain.
¹³ Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada.
¹⁴ Department of Neurological Surgery, Emory University, Atlanta, GA, USA.
¹⁵ Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA.
¹⁶ Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁷ Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada.
¹⁸ Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA. jsheehan@virginia.edu.

PMID: 36543963
DOI: 10.1007/s00701-022-05454-w

Multicenter Study

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Chloe Dumot et al. Acta Neurochir (Wien). 2023 Jan.

. 2023 Jan;165(1):211-220.

doi: 10.1007/s00701-022-05454-w. Epub 2022 Dec 22.

Authors

Affiliations

¹ Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA.
² Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France.
³ Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt.
⁴ Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt.
⁵ Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt.
⁶ Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
⁷ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
⁸ Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
⁹ Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic.
¹⁰ Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹¹ Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA.
¹² Department of Radiosurgery, Rúber International Hospital, Madrid, Spain.
¹³ Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada.
¹⁴ Department of Neurological Surgery, Emory University, Atlanta, GA, USA.
¹⁵ Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA.
¹⁶ Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁷ Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada.
¹⁸ Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA. jsheehan@virginia.edu.

PMID: 36543963
DOI: 10.1007/s00701-022-05454-w

Abstract

Background: Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old.

Method: This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up.

Results: One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients.

Conclusion: SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.

Keywords: Elderly; Koos grade IV; Stereotactic radiosurgery; Vestibular schwannoma.

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References

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Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Affiliations

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources