Tesis

Luaran Vestibular Schwannoma yang Dilakukan Gamma Knife Radiosurgery di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo = Vestibular Schwannoma Outcome Underwent Gamma Knife Radiosurgery at Cipto Mangunkusumo National General Hospital.

Vestibular Schwannoma adalah tumor yang berasal dari selubung mielin nervus vestibular. Sejak tahun 2018 peneliti memperoleh modalitas terapi baru yaitu Gamma Knife (GK). Sejak tahun 2018-2021, sebanyak 52 pasien telah diterapi menggunakan GK. Penelitian ini akan mengevaluasi luaran klinis dan temuan radiologis pasien yang diterapi dengan GK.Penelitian ini menggunakan desain observasional dengan pendekatan kohort retrospektif. Sampel menggunakan metode consecutive sampling, terdapat 40 pasien. Luaran dinilai meliputi gejala dan volume tumor pasca GK. Nyeri kepala terdapat pada 16 (40%) pasien dan 68,75% mengalami perbaikan. Penurunan pendengaran pada 24 pasien (60%) dan 13 pasien (54,16%) mengalami perbaikan. Terdapat 1 kasus baru penurunan pendengaran. 7 dari 8 pasien mengalami perbaikan baal wajah (87,5%), sekitar setengah dari pasien mengalami nyeri wajah dan kelumpuhan wajah. Perbaikan gejala gangguan keseimbangan terjadi pada 9 dari 10 pasien, terdapat 2 kasus baru pasca GK. Kontrol tumor untuk Koos derajat I sampai IV adalah 83,33%, 81,8%, 85,71%, 81,25% secara beruntun. Luaran perbaikan klinis dimulai dari paling banyak mengalami perbaikan yaitu gangguan keseimbagan (90%), baal wajah (87,5%), nyeri kepala (68,75%), nyeri wajah (55,55%), penurunan pendengaran (54,16%) dan kelumpuhan wajah (42,8%). Ditemukan 1 kasus baru penurunan pendengaran (6,25%) dan 2 kasus baru gangguan keseimbangan (6,67%).
Kata kunci: Vestibular schwannoma, gamma knife, luaran, gejala klinis, ukuran tumor


Stroke Vestibular Schwannoma (VS) is a tumor that originated from myelin sheath of the vestibular nerve. Diagnosis is carried out with history taking and physical examination, followed with radiological study either Computed Tomography Scan (CT Scan) and Magnetic Resonance Imaging (MRI), but histopathology examination is the gold standard for VS. Since 2018 we have new modality in our hospital for treating VS, namely Gamma Knife (GK). From 2018 – 2021, 52 patients with VS has been treated. We purpose a research to evaluate clinical outcome and radiological finding of VS that being treated with GK in our hospital. The research design used an observational study design with a cohort-retrospective approach. We assessed the clinical and radiological outcomes of patients diagnosed with VS who underwent GK. The method of selecting the sample was using the consecutive sampling method, populations that met the inclusion criteria and did not meet the exclusion criteria were included as a sample of 40 patients. The inclusion criteria were patients who were clinically and radiologically diagnosed with VS, then underwent GK therapy at the Gamma Knife Referral Center for Cipto Mangunkusumo National General Hospital (CMNGH). The outcomes assessed were post-GK clinical symptoms and volume measurements. Headache was found in 16 (40%) VS patients and 68.75% of them experienced improvement. Hearing loss was found in 24 patients (60%) and improved in 13 patients (54.16%) and there was 1 symptoms of hearing loss. 7 out of 8 patients had improvement of facial numbness (87.5%), around half of patients had improvement of facial pain and facial paresis (42.8%). Improvement of balance disturbances occurred in 9 out of 10 patients with 2 patients actually having these symptoms after GK. The tumor control rate for Koos Grade I to IV was 83.33%, 81.8%, 85.71% and 81.25% respectively. The outcome of the GK in VS at CMNGH Hospital had a TCR of 80% with an average follow-up of 14.23 months. Outcomes of post-CKD clinical symptoms with the highest to lowest percentage of improvement were balance disturbance (90%), facial numbness (87.5%), headache (68.75%), facial pain (55.55%), hearing loss (54.16%) and facial paresis (42.8%). Symptoms of hearing loss (6.25%) and balance disturbances (6.67%) after GK appeared.
Key words: Vestibular schwannoma, gamma knife, outcome, clinical finding, radiological finding