Radiosurgery for acoustic neuromas: results of low-dose treatment.
OBJECTIVE
The results of radiosurgical treatment of acoustic neuromas have improved by reducing the tumor marginal doses. We report relatively long-term follow-up results (>5 yr) for patients who underwent low-dose radiosurgery.


METHODS
We treated and followed 51 consecutive patients with unilateral acoustic neuromas who were treated from January 1994 to December 1996 by gamma knife radiosurgery at low doses (</=12 Gy to the tumor margin). The average age of the patients was 55 years (range, 32-76 yr). The treatment volume was 0.7 to 24.9 cm(3) (median, 3.6 cm(3)). The marginal radiation dose was 8 to 12 Gy (median, 12 Gy), and the follow-up period ranged from 18 to 96 months (median, 60 mo).


RESULTS
Clinical tumor growth control (without tumor resection) was achieved in 96% of patients, and the 5-year tumor growth control rate was 92%. Hearing was preserved in 59% of those with preradiosurgical hearing preservation (Gardner-Robertson Classes 1-4), and improvements (>20 dB of improvement) were noted in 9% of the patients with any hearing. Hearing was preserved at a useful level (Gardner-Robertson Classes 1 and 2) in 56% of patients. Although preexisting trigeminal neuropathy worsened in 4% of the patients, our patients did not experience new facial palsies or trigeminal neuropathies after radiosurgery. Facial spasm occurred in 6% of the patients, and intratumoral bleeding occurred in 4% of patients.


CONCLUSIONS
Low-dose radiosurgery (</=12 Gy at the tumor margin) can achieve a high tumor growth control rate and maintain low postradiosurgical morbidity (including hearing preservation) for acoustic neuromas.
Iwai
Yoshiyasu
Y
Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan. y-iwai@rc5.so-net.ne.jp
Yamanaka
Kazuhiro
K
Shiotani
Masato
M
Uyama
Taichi
T
D000328:Adult; D000368:Aged; D004307:Dose-Response Relationship, Radiation; D005158:Facial Paralysis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D016634:Radiosurgery / Q000009:adverse effects*; D013997:Time Factors