Neurological complications after acoustic neurinoma radiosurgery: revised risk factors based on long-term follow-up.

Abstract

Conclusions: The precise risk factors for neurological complications after acoustic neurinoma radiosurgery were identified on long-term follow-up. Type 2 neurofibromatosis was found to be a risk factor for hearing loss and peripheral tumor dose was a risk factor for seventh and fifth cranial nerve injuries. These risk factors corresponded to those reported at other institutions. At the present time, controversy exists regarding history of prior surgical resection and tumor size as risk factors for cranial nerve complications.

Objectives: To identify more precisely the risk factors for neurological complications after stereotactic radiosurgery (SRS) based on long-term follow-up.

Patients and methods: Between June 1990 and September 1998, 138 patients with acoustic neurinomas had SRS at Tokyo University Hospital. Of these, the 125 patients who were followed up for at least 6 months were entered into the present study. The patients' ages ranged from 13 to 77 years (median 53 years). The average tumor diameter ranged from 6.7 to 25.4 mm (mean 13.9 mm). The maximum tumor doses ranged from 20 to 40 Gy (mean 29.8 Gy), and the peripheral doses ranged from 12 to 25 Gy (mean 15.4 Gy). One to 12 isocenters were used (median 4). The follow-up period ranged from 6 to 191 months (median 60 months). The potential risk factors for neurological complications were analyzed using two univariate actuarial analyses. The neurological complications studied included hearing loss, facial palsy, and trigeminal nerve dysfunction. The variables analyzed were age, gender, prior operation, neurofibromatosis type 2 (NF2), tumor diameter, maximum tumor dose, peripheral tumor irradiation dose, and the number of isocenters. Variables with significant p values (<0.05) on both actuarial analyses were considered risk factors.

Results: NF2 was significantly correlated with both total hearing loss and pure tone threshold (PTA) elevation; a history of prior surgical resection, tumor size, and the peripheral tumor dose were significantly correlated with facial palsy; and the peripheral tumor dose was significantly correlated with trigeminal neuropathy.