Demographic variables of Vestibular schwannoma's patients presented in Radio Surgical out- patient department of Cyberknife Robotic Radiosurgery, JPMC Karachi.

OBJECTIVE: To determine the age, gender and sites of vestibular schwannoma cases using contrast-enhanced magnetic resonance imaging. METHOD: The retrospective descriptive study was conducted at the Department of Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with vestibular schwannomas from January 2016 to September 2018. Some of them were histologically proven and rest were radiologically proven. Cases were reviewed on contrast-enhanced magnetic resonance imaging of the brain. Statistical Package for the Social Sciences version 20 (SPSS) was applied. RESULTS: Of the 500 cases of vestibular schwannomas identified with 515 tumours, 300(60%) were males and 200(40%) were female. The overall mean age was 42.7±14.4 years (range: 17-85 years). Out of 515 tumours, the commonest site was the right cerebellopontine angle in 340(66%) cases. There were 15(3%) cases of radiologically-proven neurofibromatosis type 2. Overall, 490(98%) patients had main clinical complaint of progressive unilateral hearing loss, 5(1%) had vertigo and 5(1%) had facial palsy. CONCLUSIONS: Vestibular schwannomas were found to be more common among adults, with male preponderance and right cerebellopontine angle being the common site.

Experience of CyberKnife Robotic Radiosurgery in treating intra and extra-cranial tumours: A review of outcomes.

OBJECTIVE: To determine the success rate and complication of CyberKnife Robotic Radiosurgery for treating intracranial and extra cranial tumours. METHODS: The cross-sectional observational study was carried out at the Department of CyberKnife Robotic Radiosurgery at the Jinnah Postgraduate Medical Centre, Karachi, and reviewed data related to a year from December 2012 to December 2013. Patients referred from different hospitals within and outside Pakistan for stereotactic radiosurgery were included. The patients had benign tumours less than 7cm size, post-operative residual tumour and recurrent tumour with post-radiotherapy. Patients were followed up every three months with contrast magnetic resonance imaging. Radiosurgery was considered successful if patients improved clinically with radiologically stable disease or if there was interval reduction in the size of tumour. SPSS 17 was used for data analysis. RESULTS: Initially, 260 patients were selected, but 9(3.5%) were lost, and the final sample size was 251(96.5%). Clinically successful outcome results were seen in 225(90%) patients, while 8(3%) showed no change in symptoms and 18(7%) patients' follow-up is awaited. Radiological improvement was noted in 218(87%); stable disease in 138(55%) and 80(32%) cases showed more than 30% reduction in size after 6-12 months of follow-up. Only 5(2%) cases showed subtle increase in size within 3-month interval due to post-radiation oedema. Acute transient post-radiation changes were seen in 25(10%) patients, sub-acute changes in 4(1.59%) and 1(0.3%) patient showed radionecrosis after 9-month interval. CONCLUSIONS: Cyberknife was an effective, safe and successful treatment alternative to surgery in benign and malignant tumours with low risk of post-radiotherapy complication compared to conventional radiation.