Progression of vestibular schawnnoma after GammaKnife radiosurgery: A challenge for microsurgical resection

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Rabih Aboukaïs, Nicolas-Xavier Bonne, Gustavo Touzet, Christophe Vincent, Nicolas Reyns, Jean-Paul Lejeune
ObjectiveWe aimed to evaluate the outcome of patients who underwent salvage microsurgery for vestibular schwannoma (VS) that failed primary Gammaknife radiosurgery (GKS).Patients and Methods: Among the 1098 patients who received GKS for the treatment of VS in our center between January 2004 and December 2012, the follow-up was organized in our institution for 290 patients who lived in our recruitment area. Tumor progression was noted in 23 patients. A salvage microsurgical resection was performed in 11 patients, who were included in our study. Grading of facial function was done according to the House & Brackman scale.ResultsThe mean age at diagnosis was 50.2 years (19–68 years) and the mean follow-up was 9.4 years (4–13 years). The mean dose was 11.8 Gy (11–12 Gy) and the mean volume was 922 mm3 (208–2500 mm3). The mean period between GKS and diagnosis of tumor progression was 32 months (18–72 months). Concerning salvage microsurgery, complete resection was obtained in 8 patients. Small residual tumor on the facial nerve was deliberately left in 3 patients and no tumor progression was noted with a mean follow-up of 26 months. At last follow-up, facial nerve function was grade 1 in 4 patients, grade 2 in 3 patients, grade 3 in 1 patient and grade 4 in 3 patients.ConclusionSalvage surgery of recurrent vestibular schwannoma after failed initial GKS remains a good treatment. However, facial nerve preservation is more challenging in this case and small tumor remnant could be sometimes deliberately left.



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