| Changing Pattern of Clinical Practice in the Management of Vestibular Schwannoma: Experience in a Single Institute |
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Hong-Rae Kim, Doo-Sik Kong, Do-Hyun Nam, Kwan Park, Jong Hyun Kim, Jung-Il Lee |
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Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea |
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| Abstract |
Objective
This study was performed to identify changing pattern of clinical practice in the management of vestibular
schwannoma (VS). Particularly, analysis was focused on impact of gamma knife radiosurgery (GKS).
Methods
The clinical records of 470 patients with VS treated at the authors’ institute between 1995 and 2008 were reviewed
retrospectively. Clinical characteristics of the patients, trends regarding the usages of various treatment modalities and outcomes according to treatment modality were analyzed.
Results
GKS was introduced to the authors’ institute in 2002. 132 patients were treated before 2002 and 338 patients after
then. In the earlier period, tumors were diagnosed and treated in more advanced stages in terms of tumor size or functional status. Surgery was the prevailing treatment modality in the earlier period (111/132, 84.1%)compared with the later period
(156/338, 46.2%). Recently, GKS became the most popular primary treatment modality (182 of 338 patients; 53.8%). Overall
outcome was better with radiosurgery, which was typically used for small tumors, than microsurgery.
Conclusion
Currently more VSs are diagnosed and treated in the earlier stages. Functional preservation after treatment is considered important much more than in the past. Radiosurgery became a treatment modality more frequently used than microsurgery at the authors’ institute and produced apparently better outcome. However, further systematic investigation is required to
determine the scientific evidence for or against use of radiosurgery in various situations. |
| Key Words:
Vestibular schwannoma, Changing pattern, Gamma knife radiosurgery, Microsurgery. |
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