Outcome Analysis of Acoustic Neuroma Management: A Comparison of Microsurgery and Stereotactic Radiosurgery
AUTHOR(S): Pollock, Bruce E., M.D.; Lunsford, L. Dade, M.D., F.A.C.S.; Kondziolka, Douglas, M.D., M.Sc., F.R.C.S.(C); Flickinger, John C., M.D.; Bissonette, David J., M.B.A., P.A.-C.; Kelsey, Sheryl F., Ph.D.; Jannetta, Peter J., M.D.
Departments of Neurological Surgery (BEP, LDL, DK, JCF, DJB, PJJ), Radiology (LDL), Radiation Oncology (JCF, LDL, DK), and Epidemiology (SFK), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
ABSTRACT: Currently, microsurgical resection of acoustic neuromas by an experienced, multidisciplinary team is thought to be the treatment of choice. During the past 20 years stereotactic radiosurgery has been used as an alternative to surgical removal. To compare the results of both microsurgery and stereotactic radiosurgery, we conducted a study of 87 patients with unilateral, previously unoperated acoustic neuromas with an average diameter less than 3 cm treated by the neurosurgical service during 1990 and 1991.
Preoperative patient characteristics and average tumor size were similar between the treatment groups. State of the art microsurgical or radiosurgical techniques were used by experienced surgeons in both treatment groups. The treatment groups were compared based on cranial nerve preservation, tumor control, postoperative complications, patient symptomatology, length of hospital stay, total management charges, effect on employment status, and overall patient satisfaction. Stereotactic radiosurgery was more effective in preserving normal postoperative facial function (P < 0.05), and hearing preservation (P < 0.03) with less treatment associated morbidity (P < 0.01). Effect on preoperative symptoms were similar between the treatment groups. Postoperative functional outcomes and patients' satisfaction of their tumor management were greater after stereotactic radiosurgery when compared to the microsurgical group, although they did not reach statistical significance (P = 0.07 and P = 0.10, respectively). Patients returned to independent functioning sooner after stereotactic radiosurgery (P < 0.001). Hospital length of stay and total management charges were less in the radiosurgical group (P < 0.001).
When compared to microsurgical removal, stereotactic radiosurgery proved to be an effective and less costly management strategy of unilateral acoustic neuromas less than 3 cm in diameter. For many acoustic neuroma patients, stereotactic radiosurgery should be offered as an alternative management strategy. (Neurosurgery 36:215-229, 1995)
(Reprinted with permission)
Patients' Attitude about Outcomes and the Role of Gamma Knife Radiosurgery in the Treatment of Vestibular Schwannomas
AUTHOR(S): Hudgins, W. Robert, M.D. , Presbyterian Hospital of Dallas, Dallas, Texas
ABSTRACT: In one strategy for the treatment of unilateral vestibular schwannomas measuring up to 3 cm in diameter, decision analysis shows that gamma knife radiosurgery has probabilistic dominance over microsurgical resection. That is, radiosurgery produces better results for any value assigned to treatment outcomes (ranked from best to worst) of the following: no complications, hearing loss only, residual/recurrent tumor, facial paralysis, major disability, or death. This little-known principle of decision analysis will be explained. It implies that when patients prefer the preservation of facial nerve function, even if that requires leaving a tumor remnant, then gamma knife radiosurgery is a better treatment strategy than microsurgical resection.
(Neurosurgery 34:___-___, 1994) (Reprinted with permission)
