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Long-term outcomes after radiosurgery for acoustic neuromas
D Kondziolka1, L D Lunsford, M R McLaughlin
1Department of Neurological Surgery, University of Pittsburgh, PA 15213, USA.
The New England Journal of Medicine
|November 13, 1998
Summary
Stereotactic radiosurgery offers excellent long-term tumor control for acoustic neuromas, preserving crucial neurologic functions. This study confirms its efficacy and safety over a decade post-treatment.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Neurology
Background:
- Stereotactic radiosurgery (SRS) is a primary alternative to microsurgical resection for acoustic neuromas (vestibular schwannomas).
- Key goals of SRS include preventing tumor growth, maintaining neurologic function, and avoiding new deficits.
- While short-term SRS outcomes are documented, long-term results remain less understood.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of stereotactic radiosurgery for acoustic neuromas.
- To assess tumor control rates, preservation of neurologic functions, and patient-reported outcomes 5-10 years post-treatment.
Main Methods:
- A cohort of 162 patients with acoustic neuromas treated with SRS between 1987-1992 was assessed.
- Follow-up included serial imaging, clinical evaluations, and a patient survey 5-10 years after SRS.
- The average radiation dose was 16 Gy, with a mean tumor diameter of 22 mm; 26% had prior resections.
Main Results:
- 98% tumor control rate was achieved, with 62% of tumors shrinking and 33% remaining stable.
- Facial nerve function preserved in 79% and trigeminal function in 73% at 5 years.
- 51% maintained hearing, and no new major neurologic deficits emerged beyond 28 months post-SRS.
Conclusions:
- Stereotactic radiosurgery provides durable tumor control for acoustic neuromas.
- SRS effectively preserves essential neurologic functions, including facial nerve and hearing, long-term.
- The procedure demonstrates a favorable safety profile with manageable complications.