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Niranjan A, Faramand A, Raju SS, Lee CC, Yang HC, Nabeel AM, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Reda WA, Álvarez RM, Moreno NEM, Liscak R, May J, Mathieu D, Langlois AM, Snyder MH, Shepard MJ, Sheehan J, Muhsen BA, Borghei-Razavi H, Barnett G, Kondziolka D, Golfinos JG, Attuati L, Picozzi P, McInerney J, Daggubati LC, Warnick RE, Feliciano CE, Carro E, McCarthy D, Starke RM, Landy HJ, Cifarelli CP, Vargo JA, Flickinger J, Lunsford LD. Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study. Neurosurgery 2024; 94:165-173. [PMID: 37523519 DOI: 10.1227/neu.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Cairo , Egypt
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Cairo , Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - M Harrison Snyder
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Baha'eddin A Muhsen
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Hamid Borghei-Razavi
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Gene Barnett
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Douglas Kondziolka
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - John G Golfinos
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - Luca Attuati
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - Piero Picozzi
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - James McInerney
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Lekhaj Chand Daggubati
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati , Ohio , USA
| | - Caleb E Feliciano
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - Eric Carro
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - David McCarthy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Robert M Starke
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Howard J Landy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Christopher P Cifarelli
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John A Vargo
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John Flickinger
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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Matsushima K, Kohno M. Trigeminal Schwannoma Surgery: Challenges in Preserving Facial Sensation. Adv Tech Stand Neurosurg 2023; 46:95-107. [PMID: 37318571 DOI: 10.1007/978-3-031-28202-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Treatments of schwannoma have dramatically improved in the previous few decades, but preservation of the functions of the originating nerve, such as facial sensation in trigeminal schwannomas, still remains challenging. As the preservation of facial sensation in trigeminal schwannomas has not been analyzed in detail, we here review our surgical experience of more than 50 trigeminal schwannoma patients, particularly focusing on their facial sensation. Since the facial sensation in each trigeminal division showed a different perioperative course even in a single patient, we investigated patient-based outcomes (average of the three divisions in each patient) and division-based outcomes separately. In the evaluation of patient-based outcomes, facial sensation remained postoperatively in 96% of all the patients, and improved in 26% and worsened in 42% of patients with preoperative hypesthesia. Posterior fossa tumors tended to most rarely disrupt facial sensation preoperatively, but were the most difficult to preserve facial sensation postoperatively. Facial pain was relieved in all six patients with preoperative neuralgia. In the division-based evaluation, facial sensation remained postoperatively in 83% of all the trigeminal divisions, and improved in 41% and worsened in 24% of the divisions with preoperative hypesthesia. The V3 region was most favorable before and after surgery, with the most frequent improvement and the least frequent functional loss. To clarify current treatment outcomes of the facial sensation and to achieve more effective preservation, standardized assessment methods of perioperative facial sensation may be required. We also introduce detailed MRI investigation methods for schwannoma, including contrast-enhanced heavily T2-weighted (CISS) imaging, arterial spin labeling (ASL), and susceptibility-weighted imaging (SWI), preoperative embolization for rare vascular-rich tumors, and modified techniques of the transpetrosal approach.
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Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
- Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
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Purely Endonasal Endoscopic Approaches for Extracranial Trigeminal Nerve Schwannoma. J Craniofac Surg 2022; 33:2473-2476. [PMID: 35765130 DOI: 10.1097/scs.0000000000008687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the effectiveness and safety of purely endonasal endoscopic resection of extracranial trigeminal schwannomas (TGSs), with assessment of surgical and clinical outcomes in order to identify optimal candidates for an endonasal endoscopic approach (EEA). METHODS A retrospective review of patient's records operated for TGSs between 2008 and 2021 was conducted. Patients operated with a purely EEA were included in this study. Pictures from a frozen fresh cadaver head dissection were used to demonstrate the surgical approach and to show anatomic relationships, complexity of the surgical area and safe corridors for surgery. RESULTS A total of 5 patients (4 females and 1 male) were operated for TGS. All patients had facial numbness (100%) as a presenting symptom, followed by facial pain in 2 patients (40%), and orbital pain in 1 (20%). Also, 3 patients (60%) had a tumor originating at the level of the foramen ovale and 2 (40%) at the foramen rotundum. The mean tumor diameter was 3,7 ± 2 cm. Gross total resection were achieved in all cases. Postoperatively, 1 patient had severe mastication problems, 1 had blurred vision, and in the long-term follow-up, 1 had frontal sinusitis. The mean follow up was 106.6 (min:49, max:132, SD: 29.82) months. No recurrences were detected. CONCLUSIONS In cases with the extradural TGS having limited extension into Posterior Cranial Fossa, or located in the Middle Cranial Fossa, a purely EEA is possible even for tumors bigger in size. Unilateral endonasal corridors are adequate for resection in most cases.
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Gamma knife radiosurgery for trigeminal schwannomas: A systematic review and meta-analysis. J Clin Neurosci 2022; 101:67-79. [PMID: 35561433 DOI: 10.1016/j.jocn.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gamma knife radiosurgery (GKRS) has been deemed as the gold standard stereotactic radiosurgery (SRS) mode for the treatment of intracranial tumors, cerebrovascular diseases and brain functional diseases. Our study was aimed to systematically evaluate the efficacy, safety, and complications of gamma knife radiosurgery for trigeminal schwannomas. METHOD We performed a systematic review and meta-analysis to analyze the clinical outcomes of patients with trigeminal schwannomas treated primarily or adjunctly with GKRS. We searched two databases, Pubmed and Embase, for studies published before January 1, 2021, using GKRS for trigeminal schwannomas. Studies reporting treatment of other schwannomas, or other forms of SRS such as linear accelerator and Cyberknife were excluded to reduce its heterogeneity. RESULTS Our search achieved 351 studies, of which 35 were assessed for full-text eligibility. 19 studies were included in the meta-analysis. 456 of 504 patients (0.94, 95% CI 0.91-0.96, I2 = 3.02%, p < 0.01) from 18 studies had local control, and 278 of 489 patients (0.63, 95%CI 0.48-0.78, I2 = 88.75%, p < 0.01) from 16 studies experienced tumor regression or disappearance. 231 of 499 patients (0.50, 95% CI 0.37-0.62; I2 = 83.89%, P < 0.01) from 17 studies had clinical symptoms improved. There was no significant difference in tumor control between those treated with GKRS as either primary treatment or adjuvant to surgery(p = 0.390). CONCLUSION GKRS is an efficacious primary and adjuvant method of treating trigeminal schwannomas, with reliable tumor control rates. Randomized controlled trials are needed to further and comprehensively evaluate the benefit-to-risk ratio of gamma knife radiosurgery.
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Niranjan A, Raju SS, Kano H, Flickinger JC, Lunsford LD. Clinical and Imaging Response to Trigeminal Schwannoma Radiosurgery: A Retrospective Analysis of a 28-Year Experience. J Neurol Surg B Skull Base 2021; 82:491-499. [PMID: 34513554 DOI: 10.1055/s-0040-1714110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate long-term clinical outcomes and tumor control after stereotactic radiosurgery (SRS) for trigeminal schwannoma (TS). Methods During a 28-year period (1989-2017), 50 patients underwent SRS for TS. The median patient age was 51 years (range: 15-87 years). A total of 17 patients had a previous tumor resection: 10 had a single procedure, 5 had two procedures, and 2 had three procedures. The median and mean times between tumor resection and SRS were 12 and 24 months (range: 1-90 months), respectively. Four patients had neurofibromatosis II (NF2). Based on location, tumors were classified as root type (7), ganglion type (22), or dumbbell type (21). The median radiosurgery target volume was 3.4 cm 3 (range: 0.10-18 cm 3 ), median target dose was 14 Gy (range: 12-20 Gy), and the median number of isocenters was 6 (range: 1-15). The median and mean times to last follow-up was 36.9 and 55.2 months (range: 4-205 months), respectively. Eighteen patients (36%) had longer than 5-year follow-up, and seven patients (14%) had longer than 10-year follow-up. Results The tumor control rate was 92% and the clinical improvement or stabilization rate was 94%. After SRS, the rates of progression free survival (PFS) at 1, 5, and 10 years were 98, 84, and 84%, respectively. Factors associated with improved PFS were female sex ( p = 0.014) and smaller tumor volume ( p = 0.022). In this series, we did not find that tumor type (root, ganglion, and dumbbell) had a statistically significant correlation to PFS. Forty-seven patients had neurological signs or symptoms at presentation. At last follow-up, neurological signs or symptoms improved in 22/47 (47%), remained unchanged in 24/50 (48%), and worsened due to tumor progression in 3/50 (6%). One patient (2%) developed temporary symptomatic adverse radiation effect (ARE) and three additional patients (6%) had transient imaging evidence of peritumoral reactive edema but no new symptoms. Conclusion As a single outpatient procedure, SRS was associated with long-term freedom from additional management in 84% of patients. Nearly half the treated patients experienced improvement in neurological symptoms or signs.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Lawrence Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Long-Term Outcomes of Stereotactic Radiosurgery for Trigeminal, Facial, and Jugular Foramen Schwannoma in Comparison with Vestibular Schwannoma. Cancers (Basel) 2021; 13:cancers13051140. [PMID: 33799972 PMCID: PMC7961475 DOI: 10.3390/cancers13051140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Intracranial schwannomas are benign intracranial neoplasms. Vestibular schwannomas (VS) account for 90% of intracranial schwannomas; whereas the other cranial nerve schwannomas, such as trigeminal (TS), facial (FS), and jugular foramen schwannoma (JFS), account for 10% of all cases. Stereotactic radiosurgery (SRS) is a minimally invasive treatment for small to medium VS and known to provide excellent long-term tumor control; however, there remains a paucity of evidence regarding SRS for TS, FS, and JFS due to the rarity of these tumors. We investigated the radiosurgical outcomes of these non-vestibular schwannomas and compared them to those of VS through matched cohort analysis. Abstract Stereotactic radiosurgery (SRS) is known to provide excellent tumor control with functional preservation for vestibular schwannomas (VS), but its efficacy in the other major intracranial schwannomas including trigeminal (TS), facial (FS), and jugular foramen schwannomas (JFS) has not been established yet due to their rarity. We retrospectively analyzed data of 514 consecutive patients who had intracranial schwannomas (460 VS, 22 TS, 7 FS, and 25 JFS) and underwent SRS. The 5- and 10-year tumor control rates were 97% and 94% for VS, 100% and 100% for TS, 80% and 80% for FS, and 100% and 80% for JFS. Radiation-induced complications included one hydrocephalus for TS (4.5%), no cases for FS (0%), and one hydrocephalus and one lower palsy for JFS (8.0%). Through matched cohort analysis between patients with VS and each of the non-VS, we found no statistical difference in tumor control and radiation-induced adverse events. SRS seems to provide long-term tumor control with functional preservation for TS, FS and JFS and the efficacies are similar to VS.
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Peciu-Florianu I, Régis J, Levivier M, Dedeciusova M, Reyns N, Tuleasca C. Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:2391-2403. [PMID: 33185756 PMCID: PMC8490235 DOI: 10.1007/s10143-020-01433-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
Trigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.
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Affiliation(s)
- Iulia Peciu-Florianu
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine and Centre Hospitalier Universitaire Vaudois (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, University of Lausanne, Lausanne, Switzerland
| | - Michaela Dedeciusova
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Department of Neurosurgery and Neurooncology, Military University Hospital Prague, Prague, Czech Republic
| | - Nicolas Reyns
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Constantin Tuleasca
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France. .,Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland. .,Faculty of Biology and Medicine and Centre Hospitalier Universitaire Vaudois (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, University of Lausanne, Lausanne, Switzerland. .,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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Li M, Wang X, Chen G, Liang J, Guo H, Song G, Bao Y. Trigeminal schwannoma: a single-center experience with 43 cases and review of literature. Br J Neurosurg 2020; 35:49-56. [PMID: 32628557 DOI: 10.1080/02688697.2020.1754334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Trigeminal schwannomas (TS) are rare, when compared to vestibular schwannomas. The present study aims to analyze the clinical characteristics and surgical strategies of TS via the retrospective analysis of the clinical data of 43 patients. METHODS The clinical information of 43 patients diagnosed with TS, who were surgically treated from January 2008 to January 2018, was retrospectively analyzed. Then, the selection of approaches and surgical strategies were discussed. RESULTS During the last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University. Facial numbness and hypoesthesia were the most common symptoms, which developed in 29 cases (67.4%). Typical trigeminal neuralgia was complained by four patients (9.3%), while trigeminal motor impairment developed in nine cases (20.9%). The tumor was totally removed in 39 patients (90.7%), near-totally removed in three patients (7.0%), and partially removed in one patient (2.3%) due to intraoperative internal carotid artery (ICA) injury. The abducens was intraoperatively damaged in two patients (4.7%). After the operation, all four patients with trigeminal neuralgia achieved total recovery, but the facial numbness still continued in 24 patients (82.8%). At a median of 45.3 ± 25.5 (6-84) months of follow up, a tumor recurred in only one patient, and this patient received a second operation. CONCLUSION It can be concluded that total removal via the proper approach can be the best treatment for TS with a low complication rate. However, preoperative symptoms, such as facial numbness and trigeminal motor impairment that seldom improved though normal fibers, were carefully recognized and preserved during the operation.
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Affiliation(s)
- Mingchu Li
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Guo
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
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Yang I, Udawatta M, Prashant GN, Lagman C, Bloch O, Jensen R, Sheehan J, Kalkanis S, Warnick R. Stereotactic Radiosurgery for Neurosurgical Patients: A Historical Review and Current Perspectives. World Neurosurg 2018; 122:522-531. [PMID: 30399473 DOI: 10.1016/j.wneu.2018.10.193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/09/2022]
Abstract
Today, stereotactic radiosurgery is an effective therapy for a variety of intracranial pathology that were treated solely with open neurosurgery in the past. The technique was developed from the combination of therapeutic radiation and stereotactic devices for the precise localization of intracranial targets. Although stereotactic radiosurgery was originally performed as a partnership between neurosurgeons and radiation oncologists, this partnership has weakened in recent years, with some procedures being performed without neurosurgeons. At the same time, neurosurgeons across the United States and Canada have found their stereotactic radiosurgery training during residency inadequate. Although neurosurgeons, residency directors, and department chairs agree that stereotactic radiosurgery education and exposure during neurosurgery training could be improved, a limited number of resources exist for this kind of education. This review describes the history of stereotactic radiosurgery, assesses the state of its use and education today, and provides recommendations for the improvement of neurosurgical education in stereotactic radiosurgery for the future.
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Affiliation(s)
- Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Office of the Patient Experience, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, California, USA.
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Giyarpuram N Prashant
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Carlito Lagman
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Randy Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Steven Kalkanis
- Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
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Snyder MH, Shepard MJ, Chen CJ, Sheehan JP. Stereotactic Radiosurgery for Trigeminal Schwannomas: A 28-Year Single-Center Experience and Review of the Literature. World Neurosurg 2018; 119:e874-e881. [DOI: 10.1016/j.wneu.2018.07.289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
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Neves MWF, de Aguiar PHP, Belsuzarri TAB, de Araujo AMS, Paganelli SL, Maldaun MVC. Microsurgical Management of Trigeminal Schwannoma: Cohort Analysis and Systematic Review. J Neurol Surg B Skull Base 2018; 80:264-269. [PMID: 31143569 DOI: 10.1055/s-0038-1669418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022] Open
Abstract
Background Trigeminal schwannomas are benign tumors with a predilection for women between 40 and 60 years of age and account for less than 0.5% of all intracranial tumors. Clinical presentation depends on size and location, and typical symptoms are ipsilateral hypesthesia, headache, and facial pain. Clinical features and imaging usually make the Diagnosis. Methods A retrospective cohort analysis of 14 patients treated at our institution between January 1999 and October 2016 was performed, with a critical and systematic review of data from the literature, focusing on articles published over the same period. Results Fourteen patients were included in our series comprised of mostly women with a mean age of 40 years. Lesion size ranged from 3 to 6.5 cm (mean 4.6 cm). Clinical status of patients was evaluated and also rated based on the Karnofsky Perfomance Scale with values greater than 90% found in all patients pre and postoperatively. Surgery was our treatment of choice, and gross total resection was achieved in 71% of patients. Associated morbidity was high at 57%, predominantly from cranial nerve palsy, and no deaths were encountered. Conclusions Microsurgery is a suitable treatment for large symptomatic trigeminal schwannomas, achieving good local control rates over the observation period at acceptable morbidity. Therefore, microsurgery appears to a suitable option. During the study period, a significant evolution in the availability of treatment methods occurred. Radiosurgery emerged as an alternative treatment for unresectable lesions. A comprehensive review of the available literature was performed, and results were compared according to treatment modality.
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Affiliation(s)
- Maick Willen Fernandes Neves
- Department of Neurosurgery, Hospital Celso Pierro, Pontifícial Catholic University of Campinas, Campinas, São Paulo, Brazil
| | | | - Telmo Augusto Barba Belsuzarri
- Department of Neurosurgery, Hospital Celso Pierro, Pontifícial Catholic University of Campinas, Campinas, São Paulo, Brazil
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Ryu J, Lee SH, Choi SK, Lim YJ. Gamma knife radiosurgery for trigeminal schwannoma: a 20-year experience with long-term treatment outcome. J Neurooncol 2018; 140:89-97. [PMID: 29931615 DOI: 10.1007/s11060-018-2934-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study evaluated the long-term tumor control rate (TCR) and symptomatic outcomes of patients treated with gamma knife radiosurgery (GKRS) for trigeminal schwannomas (TSs). METHODS Thirty-two patients with TS who underwent GKRS between January 1994 and January 2013 with at least 2 years of follow-up were enrolled in the study. Clinical charts and surgical records were retrospectively reviewed to evaluate factors affecting TCR and symptomatic outcomes. The median patient age was 57.5 years (max = 81, interquartile range [IQR] = 51-67), and the median tumor volume was 3.55 cm3 (max = 25.2 cm3, IQR = 2.0-6.2 cm3). The median marginal and maximum doses were 13.0 Gy (max = 18.0 Gy, IQR = 12.5-15 Gy) and 23.8 Gy (max = 35 Gy, IQR = 21.7-25.0 Gy), respectively. RESULTS At a median follow-up of 90.5 months (max = 281 months, IQR = 49-139.75 months), the actuarial 3-, 5-, and 10-year TCR were 93.8, 86.2, and 80.8%, respectively. Our data and multivariate analysis indicated that the target volume was the only significant factor determining TCR and that larger tumors (> 5 cm3) were more likely to progress (p = 0.011). Cystic tumors had a higher incidence of transient enlargement and temporary symptom change compared to those in solid tumors. An unfavorable outcome of symptoms was observed in five patients (15.6%). Complications were observed in two patients (6.25%), including hydrocephalus and radio-induced trigeminal neuropathy, respectively. CONCLUSIONS GKRS can be a safe and effective treatment modality for TS with long-term follow-up, especially for small tumors. An extended period of follow-up observation is required to conclude the clinical response to GKRS.
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Affiliation(s)
- Jiwook Ryu
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Young Jin Lim
- Department of Neurosurgery, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
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13
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Makarenko S, Ye V, Akagami R. Natural History, Multimodal Management, and Quality of Life Outcomes of Trigeminal Schwannomas. J Neurol Surg B Skull Base 2018; 79:586-592. [PMID: 30456029 DOI: 10.1055/s-0038-1651503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/31/2018] [Indexed: 10/16/2022] Open
Abstract
Background Trigeminal schwannomas are the second most common among intracranial schwannomas. These can arise from anywhere between the root and the distal extracranial branches of the trigeminal nerve. Clinical presentation depends on location and size, including but not limited to facial hypesthesia or pain, headaches, dizziness, ataxia, and diplopia. Literature is strikingly scant discussing the natural history of these lesions, while the treatment goals are heavily dependent on tumor presentation. Management decisions must be individualized to each tumor and each patient, while attempting to maximize the quality of life. We present the natural history of these lesions as well as their management by surgical resection or radiation therapy, and report long-term quality of life outcomes. Methods Between 2001 and 2015, 24 patients (66.7% female) with trigeminal schwannomas were diagnosed and managed at Vancouver General Hospital. We analyzed the clinical presentation, surgical results, resection rates, patient quality of life, and complications. To complete the evaluation, we prospectively collected 36-Item Short Form Health Survey (SF-36) quality of life assessments for comparison. Results We identified 12 patients treated with a craniotomy and surgical resection, 4 were treated with radiation therapy, while 8 patients were followed by observation. Mean age of study cohort was 49.2 years (range, 23-79 years), and most patients presented with facial hypesthesia (54.2%) and headaches (37.5%), while 37.5% were incidental findings. There were no major differences in patient demographics between the three groups. Patients offered surgery had larger lesions (mean diameter, 3.4 ± 1.1 cm) when compared with those that were irradiated or observed, and were more likely to have extracranial extension. Overall patient quality of life improved following treatment (ΔSF-36 + 12.9) at 3.9 years. Conclusions The treatment goals of trigeminal schwannomas focus on improvement in neurologic symptoms, relief of mass effect, and preservation of cranial nerve function. We demonstrate that smaller lesions found incidentally with minimal symptoms can be followed safely with serial imaging, with 1 of 9 (11.1%) progressing to require treatment over the course of 7.1 years. Management of trigeminal schwannomas should be individualized with an involvement of a multidisciplinary skull base team.
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Affiliation(s)
- Serge Makarenko
- Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vincent Ye
- Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryojo Akagami
- Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Langlois AM, Iorio-Morin C, Masson-Côté L, Mathieu D. Gamma Knife Stereotactic Radiosurgery for Nonvestibular Cranial Nerve Schwannomas. World Neurosurg 2017; 110:e1031-e1039. [PMID: 29223524 DOI: 10.1016/j.wneu.2017.11.163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonvestibular cranial schwannomas represent a rare type of benign intracranial tumor. Few studies have evaluated the use of stereotactic radiosurgery (SRS) as a primary management option for these lesions. We performed a retrospective review of our institution's experience focusing on efficacy with regard to tumor control and clinical symptom stabilization as well as treatment safety. METHODS Patients were included if they underwent at least 1 SRS procedure for a nonvestibular schwannoma and had at least 6 months of available imaging follow-up. Demographic, SRS dose planning, clinical, and imaging data were collected from chart reviews of treated patients. χ2 and Kaplan-Meier analyses were performed. RESULTS Between 2004 and 2016, 35 schwannomas were treated in 34 patients. Median follow-up was 48 months. Median age at time of treatment was 51 years. Three patients had neurofibromatosis 2. Schwannoma location was trigeminal (57%), facial (20%), jugular foramen (14%), abducens (6%), and trochlear (3%). Median margin dose delivered was 13 Gy. The 5-year and 10-year tumor control rates were 94.4% and 88.5%, respectively. Presenting clinical symptoms stabilized or improved in 79% of cases after radiosurgery, and new or worsening symptoms were seen in 21%. CONCLUSIONS SRS is a safe and effective modality for treatment of nonvestibular cranial nerve schwannomas.
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Affiliation(s)
- Anne-Marie Langlois
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Laurence Masson-Côté
- Department of Radiation-Oncology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - David Mathieu
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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15
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D'Astous M, Ho AL, Pendharkar A, Choi CYH, Soltys SG, Gibbs IC, Tayag AT, Thompson PA, Adler JR, Chang SD. Stereotactic radiosurgery for non-vestibular cranial nerve schwanommas. J Neurooncol 2016; 131:177-183. [PMID: 27752881 DOI: 10.1007/s11060-016-2286-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
Non-vestibular cranial nerve schwannomas (NVCNS) are rare lesions, representing <10 % of cranial nerve schwannomas. The optimal treatment for NVCNS is often derived from vestibular schwannomas experience. Surgical resection has been referred to as the first line treatment for those benign tumors, but significant complication rates are reported. Stereotactic radiosurgery (SRS) has arisen as a mainstay of treatment for many benign tumors, including schwanommas. We retrospectively reviewed the outcomes of NVCNS treated by SRS to characterize tumor control, symptom relief, toxicity, and the role of hypo-fractionation of SRS dose. Eighty-eight (88) patients, with ninety-five (95) NVCNS were treated with either single or multi-session SRS from 2001 to 2014. Local control was achieved in 94 % of patients treated (median follow-up of 33 months, range 1-155). Complications were seen in 7.4 % of cases treated with SRS. At 1-year, 57 % of patients had improvement or resolution of their symptoms, while 35 % were stable and 8 % had worsening or increased symptoms. While 42 % received only one session, results on local control were similar for one or multiple sessions (p = 0.424). SRS for NVCNS is a treatment modality that provides excellent local control with minimal complication risk compared to traditional neurosurgical techniques. Tumor control obtained with a multi-session treatment was not significantly different from single session treatment. Safety profile was also comparable for uni or multi-session treatments. We concluded that, as seen in VS treated with CK SRS, radiosurgery treatment can be safely delivered in cases of NVCNS.
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Affiliation(s)
- Myreille D'Astous
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA.
- Department of Surgery, CHU de Québec, Université Laval, Quebec City, QC, Canada.
| | - Allen L Ho
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Arjun Pendharkar
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Clara Y H Choi
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Armine T Tayag
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Patricia A Thompson
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - John R Adler
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
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16
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Niranjan A, Barnett S, Anand V, Agazzi S. Multimodality Management of Trigeminal Schwannomas. J Neurol Surg B Skull Base 2016; 77:371-8. [PMID: 27441164 DOI: 10.1055/s-0036-1581138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/17/2016] [Indexed: 10/21/2022] Open
Abstract
Patients presenting with trigeminal schwannomas require multimodality management by a skull base surgical team that can offer expertise in both transcranial and transnasal approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic symptoms, preservation of cranial nerve function, and control of mass effect are the primary goals of management for trigeminal schwannomas. Complete surgical resection is the treatment of choice but may not be possible in all cases. Radiosurgery is an option as primary management for small- to moderate-sized tumors and can be used for postoperative residuals or recurrences. Planned surgical resection followed by SRS for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic resection is an excellent approach for patients with an extradural tumor or tumors isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based on high-quality imaging can help better estimate the expected outcome from each treatment. An expert skull base team should be able to provide precise counseling for each patient's situation for selecting the best option.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Samuel Barnett
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Vijay Anand
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, United States
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
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17
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Hasegawa T, Kato T, Iizuka H, Kida Y. Long-term results for trigeminal schwannomas treated with gamma knife surgery. Int J Radiat Oncol Biol Phys 2014; 87:1115-21. [PMID: 24267973 DOI: 10.1016/j.ijrobp.2013.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/02/2013] [Accepted: 09/06/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE Surgical resection is considered the desirable curative treatment for trigeminal schwannomas. However, complete resection without any complications remains challenging. During the last several decades, stereotactic radiosurgery (SRS) has emerged as a minimally invasive treatment modality. Information regarding long-term outcomes of SRS for patients harboring trigeminal schwannomas is limited because of the rarity of this tumor. The aim of this study was to evaluate long-term tumor control and functional outcomes in patients harboring trigeminal schwannomas treated with SRS, specifically with gamma knife surgery (GKS). METHODS AND MATERIALS Fifty-three patients harboring trigeminal schwannomas treated with GKS were evaluated. Of these, 2 patients (4%) had partial irradiation of the tumor, and 34 patients (64%) underwent GKS as the initial treatment. The median tumor volume was 6.0 cm(3). The median maximum and marginal doses were 28 Gy and 14 Gy, respectively. RESULTS The median follow-up period was 98 months. On the last follow-up image, 7 patients (13%) had tumor enlargement, including the 2 patients who had partial treatment. Excluding the 2 patients who had partial treatment, the actuarial 5- and 10-year progression-free survival (PFS) rates were 90% and 82%, respectively. Patients with tumors compressing the brainstem with deviation of the fourth ventricle had significantly lower PFS rates. If those patients with tumors compressing the brainstem with deviation of the fourth ventricle are excluded, the actuarial 5- and 10-year PFS rates increased to 95% and 90%, respectively. Ten percent of patients had worsened facial numbness or pain in spite of no tumor progression, indicating adverse radiation effect. CONCLUSIONS GKS can be an acceptable alternative to surgical resection in patients with trigeminal schwannomas. However, large tumors that compress the brainstem with deviation of the fourth ventricle should be surgically removed first and then treated with GKS when necessary.
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Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan.
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18
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Abstract
This article summarizes tumor control and functional outcomes of stereotactic radiosurgery (SRS) for patients with nonvestibular schwannomas, in comparison with those treated with microsurgical resection. To date, surgical resection has been a common treatment for nonvestibular schwannomas. Because these tumors are generally benign, complete tumor resection is a desirable curative treatment. However, it is almost infeasible to completely remove these tumors without any complications, even for experienced neurosurgeons, because of adherence to surrounding critical structures such as cranial nerves, brainstem, or vessels. SRS provides a good tumor control rate with much less morbidity than microsurgical resection.
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Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture 485-8520, Japan.
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