title: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas.
abstract: 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.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, Timone Hospital, Marseille, France. jregis@ap-hm.fr
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: William
authors.initials: W
authors.lastname: Pellet
authors.forename: Christine
authors.initials: C
authors.lastname: Delsanti
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.forename: Pierre Hughes
authors.initials: PH
authors.lastname: Roche
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Thomassin
authors.forename: Michel
authors.initials: M
authors.lastname: Zanaret
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Peragut
mesh_terms: 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