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Stereotactic Radiosurgery for Acoustic Neuroma: A Canadian Perspective

Published online by Cambridge University Press:  18 September 2015

Ian B. Ross  and
Charles H. Tator
Ian B. Ross*
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg
Charles H. Tator
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto
*
Section of Neurosurgery, University of Manitoba, Z3017-409 Tache Ave, Winnipeg, MB, Canada R2H 2A6
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Abstract:

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Stereotactically delivered radiation is now an accepted treatment for patients with acoustic neuroma. In some cases, patient preference may be the reason for its selection, while in others neurosurgeons may select it for patients who are elderly or have significant risk factors for conventional surgery. The majority of patients with acoustic neuroma treatment with stereotactic radiosurgery have been treated with the Gamma Knife, with follow ups of over 25 years in some instances. Other radiosurgical modalities utilizing the linear accelerator have been developed and appear promising, but there is no long-term follow up. Canada does not possess a Gamma Knife facility, and its government-funded hospital and medical insurance agencies have made it difficult for patients to obtain reimbursement for Gamma Knife treatments in other countries. We review the literature to date on the various forms of radiation treatment for acoustic neuroma and discuss the current issues facing physicians and patients in Canada who wish to obtain their treatment of choice.

Résumé:

RÉSUMÉ:

L'irradiation stéréotaxique est maintenant un traitement reconnu chez les patients qui ont un neurinome acoustique. Dans certains cas, la préférence du patient peut être la raison de ce choix, alors dans d'autres cas le neurochirurgien peut choisir ce traitement pour les patients qui sont âgés ou chez qui la chirurgie conventionnelle présente des facteurs de risque importants. La majorité des patients qui sont traités par radiochirurgie stéréotaxique pour un neurinome acoustique ont été traités au moyen du scalpel gamma, avec un suivi de plus de 25 ans dans certains cas. D'autres modalités radiochirurgicales utilisant l'accélérateur linéaire ont été développées et semblent prometteuses, mais un suivi à long terme n'est pas disponible. Le Canada n'a pas d'institution qui possède de scalpel gamma et le fait que ses hôpitaux sont subventionnés par des fonds publiques et les limites établies par les compagnies d'assurance médicale font qu'il est difficile pour les patients d'obtenir un remboursement pour le traitement par le scalpel gamma dans d'autres pays. Nous revoyons la littérature sur les différentes formes d'irradiation pour le traitement du neurinome acoustique et nous discutons des problèmes auxquels font face au Canada les médecins et les patients qui désirent obtenir le traitement de leur choix.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 4 , November 1998 , pp. 310 - 314
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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