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Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature.

Arthurs BJ, Lamoreaux WT, Giddings NA, Fairbanks RK, Mackay AR, Demakas JJ, Cooke BS, Lee CM - World J Surg Oncol (2009)

Bottom Line: Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems.We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery.Treatment resulted in an excellent radiographic response and complete hearing preservation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA. barthurs@u.washington.edu

ABSTRACT
Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

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Related in: MedlinePlus

Pre-treatment MRI. Enhanced T1-axial MRI of the brain prior to gamma knife radiosurgery showing an enhancing lesion extending into the cerebellopontine angle from the left internal acoustic meatus.
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Figure 1: Pre-treatment MRI. Enhanced T1-axial MRI of the brain prior to gamma knife radiosurgery showing an enhancing lesion extending into the cerebellopontine angle from the left internal acoustic meatus.

Mentions: After 4 months, meeting with various physicians and weighing the treatment options, the patient elected to pursue stereotactic radiosurgery. The preoperative gadolinium enhanced T1-MRI, required for Gamma Knife treatment planning, revealed the mass extending from the left acoustic meatus showing no significant expansion from the previous study (see Figure 1). The tumour received a dose of 13 Gy prescribed to the 50% isodose line, which is slightly higher than the 12 Gy currently prescribed to our patients with VS. After tolerating the procedure and undergoing a brief period of observation, the patient was discharged to her home.


Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature.

Arthurs BJ, Lamoreaux WT, Giddings NA, Fairbanks RK, Mackay AR, Demakas JJ, Cooke BS, Lee CM - World J Surg Oncol (2009)

Pre-treatment MRI. Enhanced T1-axial MRI of the brain prior to gamma knife radiosurgery showing an enhancing lesion extending into the cerebellopontine angle from the left internal acoustic meatus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803477&req=5

Figure 1: Pre-treatment MRI. Enhanced T1-axial MRI of the brain prior to gamma knife radiosurgery showing an enhancing lesion extending into the cerebellopontine angle from the left internal acoustic meatus.
Mentions: After 4 months, meeting with various physicians and weighing the treatment options, the patient elected to pursue stereotactic radiosurgery. The preoperative gadolinium enhanced T1-MRI, required for Gamma Knife treatment planning, revealed the mass extending from the left acoustic meatus showing no significant expansion from the previous study (see Figure 1). The tumour received a dose of 13 Gy prescribed to the 50% isodose line, which is slightly higher than the 12 Gy currently prescribed to our patients with VS. After tolerating the procedure and undergoing a brief period of observation, the patient was discharged to her home.

Bottom Line: Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems.We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery.Treatment resulted in an excellent radiographic response and complete hearing preservation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA. barthurs@u.washington.edu

ABSTRACT
Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities.We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

Show MeSH
Related in: MedlinePlus