Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas.
OBJECTIVE
Microsurgical excision is an established treatment for vestibular schwannoma (VS). In 1992 the authors used a patient questionnaire to evaluate the functional outcome and quality of life in a series of 224 consecutive patients. In addition, starting with gamma knife surgery (GKS) in 1992, the authors decided to use the same methodology to evaluate prospectively the results of this modality to compare the two alternatives.


METHODS
Among the 500 patients who were included prospectively, the authors only evaluated patients in whom GKS was the primary treatment for unilateral VS. Four years of follow up was available for the first 104 consecutive patients. Statistical analysis of the GKS and microsurgery populations has shown that only a comparison of Stage II and III (according to the Koos classification) was meaningful in terms of group size and preoperative risk factor distribution. Objective results and questionnaire answers from the first 97 consecutive patients were compared with the 110 patients in the microsurgery group who fulfilled the inclusion criteria. Questionnaire answers indicated that 100% of patients who underwent GKS compared with 63% of patients who underwent microsurgery had no new facial motor disturbance. Forty-nine percent of patients who underwent GKS (17% in the microsurgery study) had no ocular symptoms, and 91% of patients treated with GKS (61% in the microsurgery study) had no functional deterioration after treatment. The mean hospitalization stay was 3 days after GKS and 23 days after microsurgery. All the patients who underwent GKS who had been employed, except one, had kept the same professional activity (56% in the microsurgery study). The mean time away from work was 7 days for GKS (130 days in the microsurgery study). Among patients whose preoperative hearing level was Class 1 according to the Gardner and Robertson scale, 70% preserved functional hearing after GKS (Class 1 or 2) compared with only 37.5% in the microsurgery group.


CONCLUSIONS
Functional side effects happen during the first 2 years after radiosurgery. Findings after 4 years of follow up indicated that GKS provided better functional outcomes than microsurgery in this patient series.
Régis
Jean
J
Department of Stereotactic and Functional Neurosurgery, Timone Hospital, Marseille, France. jregis@ap-hm.fr
Pellet
William
W
Delsanti
Christine
C
Dufour
Henry
H
Roche
Pierre Hughes
PH
Thomassin
Jean Marc
JM
Zanaret
Michel
M
Peragut
Jean Claude
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D005128:Eye Diseases / Q000209:etiology; D005145:Face / Q000503:physiopathology; D005152:Facial Muscles / Q000503:physiopathology; D001068:Feeding and Eating Disorders / Q000209:etiology; D006309:Hearing; D006801:Humans; D008409:Mastication; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D011184:Postoperative Period; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects; D012677:Sensation; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000209:etiology