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Indications of Gamma Knife Radiosurgery for Vestibular Schwannomas(<SPECIAL ISSUE>Treatment of Vestibular Schwannoma)
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- Fukuoka Seiji
- Department of Neurosurgery, Nakamura Memorial Hospital
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- Takanashi Masami
- Department of Neurosurgery, Nakamura Memorial Hospital
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- Hojyo Atsufumi
- Department of Neurosurgery, Nakamura Memorial Hospital
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- Tanaka Chiharu
- Neurology, Nakamura Memorial Hospital
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- Konishi Masanori
- Otolaryngology, Nakamura Memorial Hospital
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- Nakamura Hirohiko
- Department of Neurosurgery, Nakamura Memorial Hospital
Bibliographic Information
- Other Title
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- 聴神経腫瘍に対するガンマナイフ治療 : その適応をめぐって(<特集>聴神経腫瘍の治療)
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Description
The purpose of this study was to investigate the indication of gamma knife radiosurgery for vestibular schwannomas by analyzing tumor control and possible complications using low marginal doses and conformal multiple shots to fit irregular tumor shapes. The authors evaluated 223 patients with followed-up periods ranging from 5 years to 15 years (mean 7.7 years, median 7.4 years). Marginal doses were 9 to 15 Gy (mean 12.5 Gy median 12 Gy) with corresponding treatment volumes being between 0.1 and 18.7cm^3 (mean 2.6cm^3, median 1.8cm^3). The number of isocenters varied from 2 to 24 shots (mean 9, median 9.2). The actuarial tumor control rates were 95% at 5 years and 94% at 7 years, respectively. Larger tumors (p=0.0068) and those in younger patients (p=0.093) tended to recur significantly. The preservation rates of useful hearing were 84%, 71%, and 64% at 2, 4, and 7 years, respectively. The most deterioration seemed to occur in cases with elderly patients (p=0.0048). Facial and trigeminal functions were preserved at 100%, and 97.8%, respectively. Amongst all patients, 20.6% developed transient dizziness, with persistent dizziness remaining in 1.5% of the total. Fifty-six other patients not in the long-term evaluation consecutively underwent caloric testing and static stabilometry as well as neurological exanimations to evaluate vestibular function in detail, both before and after GKRS. The results showed that 90% of the patients had already developed vestibular dysfunction before the treatment despite reported symptoms of dizziness. GKRS did not significantly affect vestibular function. Hydrocephalus was recognized in 5.5% of all patients, and seemed to occur primarily in cases with larger tumors (p=0.0189). GKRS provides a safe and effective therapy for small to medium sized tumors up to 8cm^3. Long-term hearing preservation rate may be affected by presbycusis in elderly patients.
Journal
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- Japanese Journal of Neurosurgery
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Japanese Journal of Neurosurgery 16 (2), 111-118, 2007
The Japanese Congress of Neurological Surgeons
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Details 詳細情報について
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- CRID
- 1390282679383747072
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- NII Article ID
- 110006164353
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- NII Book ID
- AN10380506
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- ISSN
- 21873100
- 0917950X
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- Text Lang
- ja
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- Data Source
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- JaLC
- Crossref
- CiNii Articles
- OpenAIRE
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- Abstract License Flag
- Disallowed