The Role of a Neurootologist in Identification of Post-radiation Complications in Patients with Vestibular Schwannoma Treated with Leksell Gamma Knife

Czech version

Authors: R. Holý ¹; J. Skutil ²; M. Navara ¹; P. Praženica ¹; P. Fundová ¹; A. Hahn ²
Authors‘ workplace: ORL klinika 3. LF UK a ÚVN – Vojenská FN Praha ¹; ORL klinika 3. LF UK a FN Královské Vinohrady, Praha ²
Published in: Cesk Slov Neurol N 2013; 76/109(2): 191-196
Category: Short Communication

Overview

Purpose:
The results of audiological-otoneurological tests before treatment of patients with vestibular schwannoma with the Leksell gamma knife were compared with findings after the treatment. The results were assessed in correlation with PC volumetry and brain MRI. Changes to the tumor size were monitored and the treatment effect evaluated. We focused on the detection of complications including deterioration of hearing, tinnitus, vertigo, instability, manifestation of neuropathy n. V, development of paresis n. VII, hyporesorptive hydrocephalus.

Patients and methods:
Between 1999 and 2009, 27 patients were fully neurootologically examined before the treatment and subsequently and repeatedly after the treatment. The follow-up after radiosurgery was 20–132 months, 50 months on average.

Results:
Treatment success rate was 81%; enlargement of the tumor was detected in 5 (19%) cases. Three of the five patients with enlarged tumors were successfully treated with reirradiation, one patient was treated using microsurgery (postoperative complications occurred), and one patient was successfully treated with corticosteroids. We detected one patient with hyporesorptive hydrocefalus progression. Total number of complications detected made up 22%.

Conclusions:
Monitoring of the otoneurological profile contributed to detection of some complications associated with the treatment with the Leksell gamma knife. Detection of complications is significant for the patient’s prognosis. The results testify to the significance of involving a neurootologist in the treatment and monitoring of patients with vestibular schwannoma.

Key words:
vestibular schwannoma – radiosurgery – gamma knife

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