Dynamics of tumor evolution after Gammaknife radiosurgery for sporadic vestibular schwannoma: defining volumetric patterns characterizing individual trajectory.

Background: Definition of tumor control and treatment failure after Gammaknife radiosurgery (GKRS) for vestibular schwannoma (VS) is still debated. The lack of knowledge on the dynamics of tumor evolution can lead to misinterpretation and subsequent inappropriate second treatment. The aim of this study was to evaluate the post-GKRS dynamics of evolution of tumor volume, and characterize volumetric patterns.

Assessing Tumor Volume for Sporadic Vestibular Schwannomas: A Comparison of Methods of Volumetry.

Introduction: The size of vestibular schwannomas (VS) is a major factor guiding the initial decision of treatment and the definition of tumor control or failure. Accurate measurement and standardized definition are mandatory; yet no standard exist. Various approximation methods using linear measures or segmental volumetry have been reported.

Long-Term Hearing Outcome After Radiosurgery for Vestibular Schwannoma: A Systematic Review and Meta-Analysis.

Background: Stereotactic radiosurgery (SRS) is one of the main treatment options in the management of small to medium size vestibular schwannomas (VSs), because of high tumor control rate and low cranial nerves morbidity. Series reporting long-term hearing outcome (>3 years) are scarce.

Objective: To perform a systematic review of the literature and meta-analysis, with the aim of focusing on long-term hearing preservation after SRS.

Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience.

Background: The standard therapy for brain metastasis was surgery combined with whole brain radiotherapy (WBRT). The latter is however, associated with important neurocognitive toxicity. To reduce this toxicity, postoperative stereotactic radiosurgery (SRS) is a promising technique.

Mask-Based versus Frame-Based Gamma Knife ICON Radiosurgery in Brain Metastases: A Prospective Randomized Trial.

Background: Radiosurgery is performed with a diversity of instruments relying usually either on a stereotactic frame or a mask for patient head fixation. Comfort and safety efficacy of the 2 systems have never been rigorously evaluated and compared.

Material And Method: Between February 2016 and January 2017, 58 patients presenting with nonsmall cell lung cancer brain metastases have been treated by Gamma Knife radiosurgery (GKS) with random use of a frame or a mask for fixation were included patients older than 18, with <5 brain metastases (at the exclusion of brainstem and optic pathway's locations) and no earlier history of radiotherapy.

Long-term results of Gamma-knife stereotactic radiosurgery for vestibular schwannomas in patients with type 2 neurofibromatosis.

Introduction: The aim of this study was to analyze the long-term results of Gamma-knife radiosurgery treatment of vestibular schwannomas in type 2 neurofibromatosis patients.

Materials And Methods: A cohort of 129 treatments for vestibular schwannomas in 103 patients was selected from a prospectively-maintained clinical database. Tumor control was assessed by volumetric analysis of the tumor at the last follow-up.

On demand Gamma-Knife strategy can be safely combined with BRAF inhibitors for the treatment of melanoma brain metastases.

Background: Both Gamma-Knife radiosurgery (GKRS) and BRAF inhibitors (BRAF-I) have been shown to be useful in melanoma patients with brain metastases (BMs), thus suggesting that it could be interesting to combine their respective advantages. However, cases of radiosensitization following conventional radiation therapy in BRAF-I treated patients have raised serious concerns about the real feasibility and risk/benefit ratio of this combination.

Patients And Methods: Review by two independent observers of brain magnetic resonance imaging (MRI) follow-up pictures, and volume and edema quantifications, and survival assessment in all patients who had been treated by GKRS and BRAF-I at a single institution.

Radiosurgery for vestibular schwannomas.

This article investigates the role of radiosurgery and stereotactic radiotherapy in the management of vestibular schwannomas (VS), reviewing the authors' own prospective cohort and the current literature. For patients with large Stage IV VS (according to the Koos classification), a combined approach with deliberate partial microsurgical removal followed by radiosurgery to the residual tumor is proposed. The authors' cohort is unique with respect to the size of the population and the length of the follow-up, and demonstrates the efficacy and safety of VS radiosurgery, with particular regard to its high rate of hearing preservation.

Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas.

Object: The roles of the wait-and-see strategy and proactive Gamma Knife surgery (GKS) in the treatment paradigm for small intracanalicular vestibular schwannomas (VSs) is still a matter of debate, especially when patients present with functional hearing. The authors compare these 2 methods.

Methods: Forty-seven patients (22 men and 25 women) harboring an intracanalicular VS were followed prospectively.

Repeat gamma knife surgery for regrowth of vestibular schwannomas.

Objective: Gamma knife surgery (GKS) has become established as a minimally invasive treatment modality for patients with vestibular schwannomas. Treatment failure and/or tumor regrowth, however, is occasionally encountered, and microsurgical resection is usually warranted in such cases. The role of repeat GKS in these situations is still unclear.

Surgical removal of vestibular schwannoma after failed gamma knife radiosurgery.

One of the main criticisms of vestibular schwannoma (VS) radiosurgery is that the risk of surgical morbidity is increased for patients whose tumor progresses in cases of failed procedures. The authors reviewed the French neurosurgical experience of operated patients after failed Gamma Knife radiosurgery (GKR). From July 1992 to December 2000, 23 unilateral VS out of the 1,000 treated patients have undergone a microsurgical procedure after failed GKR.

Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery.

Introduction: The majority of patients still lose the functionality of their hearing in spite of the technical advances in microsurgery. Our aim was to evaluate the hearing preservation potential of Gamma Knife Surgery. We have reviewed our experience and the literature in order to evaluate the probability to obtain such functional preservation and the factors influencing it.

Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure.

Rationale: Evaluate the morphological changes following radiosurgery in order to better define failure parameters.

Methods: 332 non-neurofibromatosis type 2 vestibular schwannomas not previously treated surgically or radiosurgically were subjected to Gamma Knife radiosurgery between 1992 and 2004 at the Gamma Knife Center in Marseille with at least three sequential MRI scans after radiosurgery. Five length measurements were systematically obtained.

Modern management of vestibular schwannomas.

Within the last 3 decades, microsurgery and stereotactic radiosurgery (SRS) have become well-established management options for vestibular schwannomas (VSs). Advancement in the management of VSs can be separated into three periods: the microsurgical pioneer period, the demonstration of SRS as a first-line therapy for small and medium-sized VSs, and currently, a period of SRS maturity based on a large worldwide patient accrual. The Marseille SRS experience includes 1,500 patients, with 1,000 patients having follow-up longer than 3 years.

Brainstem metastases: management using gamma knife radiosurgery.

Objective: Brainstem metastasis is an uncommon complication of systemic cancer, generally considered to have a highly unfavorable prognosis. Surgical risks are high and standard radiation or chemotherapy have little effect. The purpose of this study is to evaluate our experience using Gamma Knife radiosurgery (GKRS) for the management of brainstem metastasis.

[Cystic vestibular schwannomas].

Rationale: Patients with cystic vestibular schwannomas (VS) are a radiologically well-defined subgroup of patients who classically have poor outcome after microsurgical resection. Since Pendl's report of a high rate of failures, they are also considered as poor candidates for radiosurgery.

Material And Method: Among the 1000 consecutive patients who underwent Gamma Knife surgery in Marseilles, France between July 1992 and January 2002, we have collected and studied 54 patients with cystic VS at the time of treatment.

[Radiosurgery of vestibular schwannomas after microsurgery and combined radio-microsurgery].

Significant morbidity is expected after microsurgery for recurrent or growing residual vestibular schwannoma (VS). In order to avoid this procedure, radiosurgery appeared as an interesting alternative. The purpose of this study is to analyze the results of Gamma Knife radiosurgery in this indication.

[Surgical removal of unilateral vestibular schwannomas after failed Gamma Knife radiosurgery].

One of the primary criticismes of vestibular schwannoma (VS) radiosurgery is that the risk of surgical morbidity is increased for patients whose tumor progresses after the procedures. We reviewed the French experience of operated patients after failed Gamma Knife radiosurgery. From July 1992 to January 2002, 25 out of the 1000 treated patients underwent another treatment procedure for a gamma knife failure.

[Preserving hearing function after Gamma Knife radiosurgery for unilateral vestibular schwannoma].

Objective: The majority of the patients still lose hearing function in spite of the technical advances in microsurgery. We wanted to evaluate preservation of hearing function potential after Gamma Knife Surgery.

Material And Method: In Marseille, we performed 1000 Gamma-Knife procedures for vestibular schwannomas between July 1992 and January 2002.

[Changing radiological results, pitfalls and criteria of failure].

Rationale: To evaluate the morphological changes occurring during the Years following radiosurgery in order to better define the cure-failure parameters.

Material And Methods: Between July 1992 and January 2002 the otoneurosurgical group of the Timone Hospital in Marseille have operated 1000 vestibular schwannomas. The MR imaging performed before (at diagnosis) during and after radiosurgery (6 months, 1 year, 2 years, 3 years, 5 years, 7 years and 10 years) was carefully studied.

[Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature].

Rationale: To evaluate the functional results of Gamma Knife surgery of vestibular schwannomas relying on a large and prospective series of consecutive cases.

Material And Method: The first 1000 patients with cerebello-pontine angle schwannomas were consecutively treated by Gamma Knife in Marseille Timone University Hospital between July 1992 and March 2001. Patients without NF2 and or clinico-radiological arguments in favor of a facial origin accounted for a population of 927 patients (414 males, for 513 females) including 843 treated in first intention.

Relative indications for radiosurgery and microsurgery for acoustic schwannoma.

The physical and biological principles underlying the use of radiosurgery for the treatment of vestibular schwannomas of up to 2.5 cm in diameter are reviewed together with the historical controversies that have surrounded its introduction. The results in terms of mortality, quality of life, preservation of facial movement and hearing, incidence of shunt-dependent hydrocephalus, cancer neogenesis and brain stem damage are compared in the Marseilles series of 600 microsurgical procedures and 830 Gamma knife procedures and with the peer-reviewed literature.

[Preservation of hearing function in the radiosurgical treatment of unilateral vestibular schwannomas. Preliminary results].

Introduction: Preservation of functional hearing can be now attempted during the surgical treatment of a vestibular schwannomas. The probability of functional hearing preservation for each of the neurosurgical approaches is currently under evaluation. We report here a preliminary evaluation of our radiosurgical experience.

Impact of the model C and Automatic Positioning System on gamma knife radiosurgery: an evaluation in vestibular schwannomas.

Object: The technical advances associated with the model C gamma knife include a robotized system enabling automatic positioning of the stereotactic coordinates. The purpose of this study was to analyze the clinical impact of this technical modification.

Methods: The authors studied a sample of patients with vestibular schwannoma (VS).