Radiosurgery results for solid and cystic vestibular schwannomas
Abstract
Stereotactic radiosurgery of vestibular schwannomas is an effective method of treatment, comparable in its results to the surgical removal of these tumors. However, it is widely believed that radiosurgery is ineffective in treating cystic tumors.
THE AIM of this study was to investigate the patterns of changes in the solid and cystic vestibular schwannomas in the short-term and long-term period after radiosurgery.
MATERIALS AND METHODS: from April 2005 to December 2015, stereotactic radiosurgery was performed in 923 patients with unilateral VS. 333 people were available to assess the dynamics. The median follow-up was 55 months, the mean follow-up time was 60 months. Men 26.7 %, women 73.4 %. The median age was 48.2 years. The average initial tumor volume was 4.1 cm3 . The tumors were divided into 3 groups: 1st – solid tumors without cystic inclusions (n = 147); 2nd – cystic, with single or multiple small cysts, with thick walls (n = 147); 3rd – with single or multiple thin-walled cysts (n = 39). The assessment of the dynamics of changes was carried out by volumetric comparison in each observation interval.
RESULTS: pseudo-progression of neuromas was observed in 1, 2 and 3 groups in 44 %, 48 % and 28.2 %, respectively. The mean duration of pseudo-progression was 6.8, 3.5, and 2.2 years, respectively. The 5- and 10-year progression-free survival rates in the groups were 80 %, 87 %, 97 % and 76 %, 76 %, 97 %, respectively.
CONCLUSION: radiosurgery of vestibular schwannomas is an effective and safe method of treatment, and the thinwalled cystic structure is a favorable prognostic factor for a shorter course of pseudoprogression and a high survival rate without progression.
About the Authors
S. R. Ilyalov
Center of high precision radiology «Gamma Clinic» (LLC «Gamma Medtechnology»)
Russian Federation
Russian Federation
Obninsk
S. M. Banov
FSAI national medical research center of neurosurgery N.N. Burdenko
Russian Federation
Russian Federation
A. V. Golanov
FSAI national medical research center of neurosurgery N.N. Burdenko
Russian Federation
Russian Federation
D. Yu. Usachev
FSAI national medical research center of neurosurgery N.N. Burdenko
Russian Federation
Russian Federation
References
1. Kendall B, Symon L. Investigation of patients presenting with cerebellopontine angle syndromes. Neuroradiology. 1977 Apr 18;13(2):65–84. https://doi.org/10.1007/BF00339839
2. Robbins B, Marshall WH Jr. Computed tomography of acoustic neurinoma Radiology. 1978 Aug;128(2):367–70. https://doi.org/10.1148/128.2.367
3. Charabi S, Tos M, Børgesen, SE, Thomsen J. Cystic Acoustic Neuromas. Results of Translabyrinthine Surgery Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1333-8. https://doi.org/10.1001/archotol.1994.01880360031006
4. Kingsley DP, Thornton A, Furneaux C, King TT. Transmural passage of subarachnoid metrizamide into a cystic acoustic schwannoma of the cerebellopontine angle: a diagnostic dilemma. Neuroradiology. 1984;26(4):319–21. https://doi.org/10.1007/BF00339778
5. Lunsford LD, Bowden G. The Response of Cystic Acoustic Neuromas to Radiosurgery. Neurosurgery. 2017 Jan 1;80(1):119 https://doi.org/10.1093/neuros/nyw011
6. Sanna M, Mancini F, Russo A, Taibah A, Falcioni M, Trapani GD, editors. Atlas of Acoustic Neurinoma Microsurgery. Georg Thieme Verlag; 2011; http://doi.org/10.1055/b002–66280
7. Wandong S, Meng L, Xingang L, Yuguang L, Shugan Z, Lei W, et al. Cystic acoustic neuroma. Journal of Clinical Neuroscience [Internet]. Elsevier BV; 2005 Apr;12(3):253–5. https://doi.org/10.1016/j.jocn.2004.03.040
8. Kingsley DP, Thornton A, Furneaux C, King TT. Transmural passage of subarachnoid metrizamide into a cystic acoustic schwannoma of the cerebellopontine angle: a diagnostic dilemma. Neuroradiology. 1984;26(4):319–21. https://doi.org/10.1007/BF00339778
9. Lohle PNM, Wurzer HAL, Seelen PJ, Kingma LM, Go KG. Cystic lesions accompanying extra-axial tumors. Neuroradiology [Internet]. Springer Science and Business Media LLC; 1999 Jan 15;41(1):13–7. https://doi.org/10.1007/s002340050696
10. Tali ET., Yuh WT., Nguyen HD., Feng G., Koci TM., Jinkins JR. et al. Cystic acoustic schwannomas: MR characteristics. American Journal of Neuroradiology 1993; 14(5): 1241–7 PMID: 8237710
11. Olivecrona H. Acoustic Tumors. Journal of Neurosurgery [Internet]. Journal of Neurosurgery Publishing Group (JNSPG); 1967 Jan;26(1part1):6–13. https://doi.org/10.3171/jns.1967.26.1part1.0006
12. Charabi S, Klinken L, Tos M, Thomsen J. Histopathology and growth pattern of cystic acoustic neuromas. Laryngoscope. 1994 Nov;104(11 Pt 1):1348–52. https://doi.org/10.1288/0000553719941100000006
13. Charabi S, Tos M, Børgesen, SE, Thomsen J. Cystic Acoustic Neuromas. Results of Translabyrinthine Surgery Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1333–8. https://doi.org/10.1001/archotol.1994.01880360031006
14. Kameyama S, Tanaka R, Kawaguchi T, Fukuda M, Oyanagi K. Cystic acoustic neurinomas: Studies of 14 cases. Acta Neurochirurgica [Internet]. Springer Science and Business Media LLC; 1996 Jun;138(6):695–9 https://doi.org/10.1007/BF01411474
15. Fundová P, Charabi S, Tos M, Thomsen J. Cystic vestibular schwannoma: surgical outcome. J Laryngol Otol. 2000 Dec;114(12):935–9. https://doi.org/10.1258/0022215001904653
16. Sinha S, Sharma BS. Cystic acoustic neuromas: surgical outcome in a series of 58 patients. J Clin Neurosci. 2008 May;15(5):511–5. https://doi.org/10.1016/j.jocn.2007.01.007
17. Shirato H, Sakamoto T, Takeichi N, Aoyama H, Suzuki K, KageiK, et al. Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS. International Journal of Radiation Oncology*Biology*Physics [Internet]. Elsevier BV; 2000 Dec;48(5):1395–401. https://doi.org/10.1016/s0360–3016(00)007318
18. Frisch CD, Jacob JT, Carlson ML, Foote RL, Driscoll CLW, Neff BA, et al. Stereotactic Radiosurgery for Cystic Vestibular Schwannomas. Neurosurgery [Internet]. Oxford University Press (OUP); 2016 Aug 4;80(1):112–8 https://doi.org/10.1227/NEU.0000000000001376
19. Wu C–C, Guo W-Y, Chung W-Y, Wu H-M, Lin C-J, Lee C–C, et al. Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery. Journal of Neurosurgery [Internet]. Journal of Neurosurgery Publishing Group (JNSPG); 2017 Dec;127(6):1384–91. https://doi.org/10.3171/2016.9.JNS161510
20. Lim SH, Park CK, Park BJ, Lim YJ. Long-Term Outcomes of Gamma Knife Radiosurgery for Cystic Vestibular Schwannomas. World Neurosurgery [Internet]. Elsevier BV; 2019 Dec;132: e34–e39. https://doi.org/10.1016/j.wneu.2019.09.009
21. Bowden G, Cavaleri J, III EM, Niranjan A, Flickinger J, Lunsford LD. Cystic Vestibular Schwannomas Respond Best to Radiosurgery. Neurosurgery [Internet]. Oxford University Press (OUP); 2017 Mar 28;81(3):490–7 https://doi.org/10.1093/neuros/nyx027
22. Ding K, Ng E, Romiyo P, Dejam D, Udawatta M, Sun MZ, et al. Metaanalysis of tumor control rates in patients undergoing stereotactic radiosurgery for cystic vestibular schwannomas. Clinical Neurology and Neurosurgery [Internet]. Elsevier BV; 2020 Jan;188:105571 https://doi.org/10.1016/j.clineuro.2019.105571
23. Massaad E, Hamidi N, Goetz J, Padmanaban V, Mau C, Tsang D, et al. Equivalent Efficacy and Safety of Radiosurgery for Cystic and Solid Vestibular Schwannomas: A Systematic Review. World Neurosurgery [Internet]. Elsevier BV; 2021 Feb;146:322–331.e1 https://doi.org/10.1016/j.wneu.2020.11.040
Review
For citations:
Ilyalov S.R., Banov S.M., Golanov A.V., Usachev D.Yu. Radiosurgery results for solid and cystic vestibular schwannomas. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2021;13(3):19-25. (In Russ.)
Views:
45
Email this article 