We studied tumor response and clinical outcomes after SRS in such patients.

METHODS: We reviewed long-term outcomes in 55 patients with vestibular selleck compound schwannomas. Patients

were 40 years of age or younger, underwent gamma knife (GK) SRS between 1987 and 2003, and were followed up for a minimum of 4 years. The median patient age was 35 years (range, 13-40 years). Forty-one patients had Gardner-Robertson class 1 to 4 hearing. Thirteen patients (24%) had undergone surgical removal. The median tumor volume was 1.7 mm(3). The median tumor margin dose was 13.0 Gy (range, 11-20 Gy).

RESULTS: At a median of 5.3 years, (range, 4-20 years), 2 of 55 patients underwent GK SRS for a second time; 1 of these patients had had a recurrence after initial resection. The 5-year rate of freedom from additional management was 96%. Hearing preservation rates (i.e., remaining within the same Gardner-Robertson hearing class) MK-2206 order were 93%, 87%, and 87% at 3, 5, and 10 years, respectively. In patients with serviceable hearing before

SRS, it was maintained in 100%, 93%, and 93.% of patients at 3, 5, and 10 years, respectively. Hearing preservation was related to a margin dose lower than 13 Gy (P = 0.017). At the last assessment, facial and trigeminal nerve function was preserved in 98.2% and 96.4% of patients, respectively; the only facial deficit (House-Brackmann grade III) occurred in a patient who received a tumor dose of 20 Gy early in our experience (1988). None of the patients treated with doses lower than 13 Gy experienced facial

or trigeminal neuropathy. All patients continued their previous level of activity or employment after GK SRS. No patient developed a secondary radiation-related tumor.

CONCLUSION: Our experience indicates that GK SRS is an effective management strategy for younger patients with vestibular schwannoma, most of whom have no additional cranial nerve dysfunction.”
“Boolean networks and, more generally, probabilistic Boolean networks, as one class of gene regulatory networks, model biological processes with the network dynamics determined by the logic-rule regulatory functions in conjunction Caspase Inhibitor VI mouse with probabilistic parameters involved in network transitions. While there has been significant research on applying different control policies to alter network dynamics as future gene therapeutic intervention, we have seen less work on understanding the sensitivity of network dynamics with respect to perturbations to networks, including regulatory rules and the involved parameters. which is particularly critical for the design of intervention strategies. This paper studies this less investigated issue of network sensitivity in the long run. As the underlying model of probabilistic Boolean networks is a finite Markov chain, we define the network sensitivity based on the steady-state distributions of probabilistic Boolean networks and call it long-run sensitivity.