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Abstract：
OBJECTIVE: Limited data provides guidance on the management of vestibular schwannomas (VSs) that have progressed despite primary Gamma Knife radiosurgery (GKRS). The present article reports our long-term experience after repeat GKRS for VS with sustained progression after solely primary GKRS management.
METHODS: A retrospective review of 1997 patients managed between 1987 and 2023 was conducted. Eighteen patients had sustained tumor progression after primary GKRS and underwent repeat GKRS. The median repeat GKRS margin dose was 11 Gy (IQR: 11-12), the median tumor volume was 2.0 cc (IQR: 1.3-6.3), and the median cochlear dose in patients with preserved hearing was 3.9 Gy (IQR: 3-4.1). The median time between initial and repeat GKRS was 65 months (IQR: 38-118).
RESULTS: The median follow-up was 70 months (IQR: 23-101). After repeat GKRS, two patients had further tumor progression at 4 and 21 months and required partial resection of their tumors. The 10-year actuarial tumor control rate after repeat GKRS was 88%. Facial nerve function was preserved in 13 patients who had House-Brackmann grade 1 or 2 function at the time of repeat GKRS. Two patients with serviceable hearing preservation (Gardner-Robertson grade 1 or 2) at repeat GKRS retained that function afterwards. In patients with tinnitus, vestibular dysfunction, and trigeminal neuropathy, symptoms remained stable or improved for 16/16 patients, 12/15 patients, and 10/12 patients, respectively. One patient developed facial twitching in the absence of tumor growth 21 months after repeat GKRS.
CONCLUSIONS: Repeat GKRS effectively controlled tumor growth and preserved cranial nerve outcomes in most patients whose VS had sustained progression after initial primary radiosurgery.
METHODS: A retrospective review of 1997 patients managed between 1987 and 2023 was conducted. Eighteen patients had sustained tumor progression after primary GKRS and underwent repeat GKRS. The median repeat GKRS margin dose was 11 Gy (IQR: 11-12), the median tumor volume was 2.0 cc (IQR: 1.3-6.3), and the median cochlear dose in patients with preserved hearing was 3.9 Gy (IQR: 3-4.1). The median time between initial and repeat GKRS was 65 months (IQR: 38-118).
RESULTS: The median follow-up was 70 months (IQR: 23-101). After repeat GKRS, two patients had further tumor progression at 4 and 21 months and required partial resection of their tumors. The 10-year actuarial tumor control rate after repeat GKRS was 88%. Facial nerve function was preserved in 13 patients who had House-Brackmann grade 1 or 2 function at the time of repeat GKRS. Two patients with serviceable hearing preservation (Gardner-Robertson grade 1 or 2) at repeat GKRS retained that function afterwards. In patients with tinnitus, vestibular dysfunction, and trigeminal neuropathy, symptoms remained stable or improved for 16/16 patients, 12/15 patients, and 10/12 patients, respectively. One patient developed facial twitching in the absence of tumor growth 21 months after repeat GKRS.
CONCLUSIONS: Repeat GKRS effectively controlled tumor growth and preserved cranial nerve outcomes in most patients whose VS had sustained progression after initial primary radiosurgery.
摘要：
目的：有限的数据为前庭神经鞘瘤（VSs）的治疗提供了指导，尽管原发性伽玛刀放射外科（GKRS）仍在发展。本文报告了我们的长期经验，即在仅进行原发性GKRS管理后，对VS重复进行GKRS并持续进展。
方法：对1987年至2023年期间管理的1997例患者进行了回顾性回顾。18例患者在原发性GKRS后肿瘤进展持续，并接受了重复的GKRS。中位重复GKRS边缘剂量为11Gy（IQR：11-12），中位肿瘤体积为2.0cc(IQR：1.3-6.3)，听力保留患者的中位耳蜗剂量为3.9Gy（IQR：3-4.1）。初始和重复GKRS之间的中位时间为65个月(IQR:38-118)。
结果：中位随访时间为70个月（IQR：23-101）。重复GKRS后，2例患者在4个月和21个月时肿瘤进一步进展,需要部分切除肿瘤.重复GKRS后10年精算肿瘤控制率为88%。在重复GKRS时，有13例House-Brackmann1或2级功能的患者保留了面神经功能。两名在重复GKRS时具有可使用的听力保留（Gardner-Robertson1级或2级）的患者随后保留了该功能。在耳鸣患者中，前庭功能障碍,三叉神经病变,16/16患者的症状保持稳定或改善，12/15患者，和10/12的患者，分别。重复GKRS后21个月，一名患者在没有肿瘤生长的情况下出现了面部抽搐。
结论：重复GKRS可有效控制肿瘤生长并保留大多数患者的颅神经预后，这些患者在初次放射外科手术后VS持续进展。
方法：对1987年至2023年期间管理的1997例患者进行了回顾性回顾。18例患者在原发性GKRS后肿瘤进展持续，并接受了重复的GKRS。中位重复GKRS边缘剂量为11Gy（IQR：11-12），中位肿瘤体积为2.0cc(IQR：1.3-6.3)，听力保留患者的中位耳蜗剂量为3.9Gy（IQR：3-4.1）。初始和重复GKRS之间的中位时间为65个月(IQR:38-118)。
结果：中位随访时间为70个月（IQR：23-101）。重复GKRS后，2例患者在4个月和21个月时肿瘤进一步进展,需要部分切除肿瘤.重复GKRS后10年精算肿瘤控制率为88%。在重复GKRS时，有13例House-Brackmann1或2级功能的患者保留了面神经功能。两名在重复GKRS时具有可使用的听力保留（Gardner-Robertson1级或2级）的患者随后保留了该功能。在耳鸣患者中，前庭功能障碍,三叉神经病变,16/16患者的症状保持稳定或改善，12/15患者，和10/12的患者，分别。重复GKRS后21个月，一名患者在没有肿瘤生长的情况下出现了面部抽搐。
结论：重复GKRS可有效控制肿瘤生长并保留大多数患者的颅神经预后，这些患者在初次放射外科手术后VS持续进展。
