Radiosurgery of vestibular schwannomas: A minimally invasive alternative to microsurgery

From April 1992 till December 1998 stereotactic radiosurgery (Gamma Knife) was applied to 192 patients with vestibular schwannomas, 56 of them had rad iosurgery as primary treatment modality and were followed-up for at least 4 pears (48-80 months, median 62). Without fatal complications, control of tumour growth was achieved in all b ut three cases, useful hearing bring preserved in more than one half of the patients (62%). The neurological stare improved in 30 patients (54%). Irra diation-associated adverse effects (18%) comprised neurological signs (inco mplete Facial Daisy, four cases (two recovered completely), and mild trigem inal neuropathy, three cases. respectively) and morphological changes (thre e patients) marked by an enlargement of pre-existing cystic components call ing for additional surgical treatment: Microsurgical decompression was perf ormed in two cases, the third patient underwent a shunting procedure becaus e of hydrocephalus formation. Based on the present data, radiosurgery represents an effective treatment F or vestibular schwannomas associated with an exceptionally low mortality ra te and a good quality of life. With respect to the preservation of cranial nerve function, results are comparable to microsurgical resection. A short duration of hospitalization and a quick return to normal activities constit ute further advantages and contribute to cost effectiveness in public healt h care.