As many of you know, I am a person that looks for trends and relies on data so that persons can make an informed choice. This report was posted on the other patient listserv.
It was a small study done on patients who chose surgery after GK. The conclusion suggests that it is more difficult to operate after radiation which makes sense because the treatment "burns" the region. Of the findings, the facial nerve preservation was what caught my eye as all of the patients had lost hearing prior to the surgery.
<The function of the facial nerve deteriorated in 3 patients, was unchanged in 7, and improved in 2.> That means in 75% of the cases, facial nerve function was unchanged or improved..
That being said, if radiation arrests the tumor in 97% of the patients, surgery would never need to be a consideration.
Microsurgery for vestibular schwannoma after gamma knife radiosurgery.
Shuto T, Inomori S, Matsunaga S, Fujino H.
Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan, email@example.com.
Background. We evaluated the clinical characteristics of microsurgery for vestibular schwannoma (VS) after failed gamma knife radiosurgery (GKS).
Method. Twelve patients, 5 men and 7 women aged 19 to 70 years (mean 54.5 years), who underwent microsurgery after failed GKS for VS were studied retrospectively.
Findings. The median interval between GKS and microsurgery was 28.8 months (range, 6.6-120 months) and 4 patients had undergone previous microsurgery. The mean volume of tumour at GKS was 6.9 cm(3) (range, 0.5-19.7 cm(3)) and the mean prescription dose to the tumour margin was 12.3 Gy. Microsurgery involved the lateral suboccipital approach in all patients. Tumour expansion involved solid enlargement in 7 patients, cystic enlargement in 3, and central necrosis in 2.Bleeding was slight in all patients except in one, probably because of the pr evious irradiation. Adhesion to the brain stem was severe in 7 patients. Identification of the facial nerve was easy in 5 operations and difficult in 7. Dissection of the tumour from the facial nerve was difficult in most interventions because of severe adhesions or colour change. Severe adhesions between the trigeminal nerve and the tumour was observed in 2 patients. The tumour was subtotally removed except around the internal auditory canal in most patients. Only one residual tumour increased in size and needed second GKS. The function of the facial nerve deteriorated in 3 patients, was unchanged in 7, and improved in 2. All patients had lost hearing on the affected side at the time of microsurgery.
Conclusions. Microsurgery for VS after failed GKS presents some technical difficulties. Dissection of the tumour from the facial nerve or brain stem is likely to be difficult. We recommend subtotal resection without dissection of the facial nerve and tumour, because growth of the residual tumour was rare in our series.
PMID: 18253695 [PubMed - as supplied by publisher]