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Linear accelerator radiosurgery for vestibular schwannoma.
R Spiegelmann1, Z Lidar, J Gofman
1Department of Neurosurgery, Radiation Physics, and Radiation Oncology, and The Stereotactic Radiosurgery Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel. spiegel@inter.net.net.il
Journal of Neurosurgery
|January 9, 2001
Summary
Linear accelerator (LINAC) radiosurgery effectively treats acoustic neuromas, achieving high tumor control and hearing preservation rates. Lower radiation doses may reduce facial nerve complications, especially for larger tumors.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Acoustic neuroma treatment has increasingly utilized radiosurgery.
- Gamma knife radiosurgery is the most commonly reported modality.
- This study evaluates linear accelerator (LINAC) radiosurgery for acoustic neuromas.
Purpose of the Study:
- To review the methods and outcomes of LINAC radiosurgery for acoustic neuromas.
- To assess tumor control, hearing preservation, and facial nerve function.
- To evaluate the impact of radiation dose on treatment outcomes.
Main Methods:
- 44 patients with acoustic neuromas treated with LINAC radiosurgery between 1993-1997.
- Stereotactic imaging using computerized tomography for target definition.
- Single isocenter LINAC radiosurgery with dose adjustments (11-20 Gy) based on tumor size and follow-up duration.
Main Results:
- 98% tumor control after a mean follow-up of 32 months.
- Actuarial hearing preservation rate of 71%.
- Facial neuropathy occurred in 24% (transient) and 8% (persistent mild), with dose correlating to neuropathy incidence in larger tumors.
Conclusions:
- Single-isocenter LINAC radiosurgery is an effective treatment for acoustic neuromas.
- Outcomes are comparable to gamma knife radiosurgery and multiple isocenter techniques.
- Radiation dose optimization is crucial for minimizing cranial neuropathy, particularly in large tumors.