Hafez Raef F A, Morgan Magad S, Fahmy Osama M, Hassan Hamdy T
Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42km. Ismailia Desert Road, Cairo, Egypt.
Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42km. Ismailia Desert Road, Cairo, Egypt.
Clin Neurol Neurosurg. 2020 Nov;198:106171. doi: 10.1016/j.clineuro.2020.106171. Epub 2020 Aug 27.
Gamma Knife surgery has become an accepted treatment for small to medium‑size vestibular schwannoma with a high rate of tumor control and good clinical outcome. When GKS treatment fails to stop tumor growth, GKS retreatment can be proposed in selected cases. This retrospective study examines the clinical and tumor control outcome after the second GKS retreatment for the same vestibular schwannomas.
A total of 14 consecutive vestibular schwannomas patients retreated with 2nd GKS were included: The median time interval between GKS treatments was 44 months, and the median follow‑up duration after last GKS retreatment was 60 months. The median marginal dose used for the first and second treatments was 12 Gy. The median tumor volume at the initial GKS was 2.4cc (range 0.27-3.8) and was 3.8cc (range 1.21-7.6) at the GKS retreatment.
At the last follow‑up, 93% (13 patients) had tumor growth control, decreased in 4, remained unchanged in 9, and increased tumor size in one patient. New facial or severe trigeminal palsy did not occur after the second GKS retreatment. The hearing was not preserved except in one patient post-GKS retreatment.
GKS retreatment after the failure of initial GKS to control vestibular schwannomas growth appears to be an effective strategy and can be proposed as an alternative to microsurgery when the tumor volume remains within the usual radiosurgical range.
伽玛刀手术已成为治疗中小型前庭神经鞘瘤的一种公认方法，肿瘤控制率高且临床效果良好。当伽玛刀治疗未能阻止肿瘤生长时，在特定病例中可考虑进行伽玛刀再次治疗。本回顾性研究探讨了同一前庭神经鞘瘤第二次伽玛刀再次治疗后的临床及肿瘤控制结果。
共纳入14例接受第二次伽玛刀再次治疗的连续前庭神经鞘瘤患者：伽玛刀治疗之间的中位时间间隔为44个月，最后一次伽玛刀再次治疗后的中位随访时间为60个月。第一次和第二次治疗使用的中位边缘剂量为12 Gy。初次伽玛刀治疗时的中位肿瘤体积为2.4立方厘米（范围0.27 - 3.8），伽玛刀再次治疗时为3.8立方厘米（范围1.21 - 7.6）。
在最后一次随访时，93%（13例患者）实现了肿瘤生长控制，4例缩小，9例不变，1例患者肿瘤大小增加。第二次伽玛刀再次治疗后未出现新的面部或严重三叉神经麻痹。除1例伽玛刀再次治疗后的患者外，听力均未保留。
初次伽玛刀治疗未能控制前庭神经鞘瘤生长后进行伽玛刀再次治疗似乎是一种有效的策略，当肿瘤体积仍在常规放射外科治疗范围内时，可作为显微手术的替代方法。
