S.V. Zolotova, N.G. Nikonova, S.R. Ilyalov, A.V. Golanov, D.N. Kapitanov, T.M. Kotelnikova, O.I. Soboleva, V.V. Kostyuchenko, G.E. Gorlachev, N.V. Artyunov, A.E. Podoprigora, S.V. Serkov
Burdenko Research Institute of Neurosurgery, Moscow, Russia
Development of neurovisualization methods has resulted in considerable increase of a rate of vestibular schwannoma (VS) diagnosis at an early stage, i.e. before appearance of hypertensive-hydrocephalic and stem symptoms. Such cases can be treated with stereotaxis radiosurgery (SRS) and radiotherapy (SRT). There were 220 cases with VS, aged 14-81, who were treated at our Institute in 2005-2008. Diagnosis was verified histologically in 62 cases (28%) after tumor removal; it was done on the basis of clinical and rentgenologic data in the rest patients. SRS with applying the Gamma-Knife apparatus and the Novalis linear accelerator was used in 160 and 38 casesrespectively; SRT was carried out in 22 cases. Data of control examination were available in 179 patients. A tumor growth was arrested in 99% of cases. Hydrocephalus, which developed in 8 cases, demanded use of a shunting system in 3 of them. Dynamics of hearing disorders was estimated on the basis of the following criteria: 1 - hearing stabilization or a number of cases, whose hearing remained unchanged (except the deaf): 2 - preserved “useful” hearing or changes of hearing in cases with its good level before treatment (the score of I-II according to Gardner-Robertson scale). These indices were 69% and 61.7%, respectively. There were transient functional disorders of the trigeminal (paresthesia or hemifacial spasm) and facial (the score of I-II according to House-Breckman scale) nerves, watched in 9% and 6% of cases, respectively.
Today SRS and SRT become methods of choice for cases with VS. A long-term catamnestic follow-up (up to 4 years) has demonstrated, that they are characterized by excellent control of tumor growth and preserved of function of craniocerebral nerves.