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Bouttelgier RM, Berghe CV, Vantomme N, Cambron M, Casselman JW. Imaging of trochlear nerve schwannomas: a case series and systematic review of the literature. Br J Neurosurg 2023:1-7. [PMID: 37966054 DOI: 10.1080/02688697.2023.2280601] [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: 10/13/2021] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Abstract
Purpose Trochlear nerve schwannomas are rare tumors. So far, only 121 cases have been published. We present four new cases, discuss the imaging characteristics and summarize all previously published cases through a systematic review.Methods Four cases, all treated in AZ Sint-Jan Hospital Brugge-Oostende (Belgium), were collected, including their demographic, clinical and radiological data. All MR imaging was performed with the three-dimensional fluid-attenuated inversion recovery (3D-FLAIR), turbo spin echo T1 high-resolution (TSE T1 HR), three-dimensional balanced fast-field echo (3D b-FFE) and three-dimensional T1 black blood (3D T1 black blood) sequence. We compared our findings with the present literature through a systematic literature review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Screening with routine unenhanced 3D-FLAIR imaging could identify all schwannomas as hyperintense lesions on the course of the trochlear nerve. The use of 3D T1 black blood sequences was superior in depicting the lesions, while high-resolution 3D b-FFE images enabled us to visualize the anatomic boundaries of the lesions in detail. Most trochlear schwannomas are located in the ambient cistern, at or just below the free edge of the tentorium.Conclusion The majority of trochlear nerve schwannomas are located cisternal and display variable enhancement on contrast administration. 3D-FLAIR imaging is superior in detecting these lesions. Comparison with data collected from previous cases demonstrates the importance of early diagnosis and treatment. Generally, patients with trochlear nerve schwannomas have a good prognosis.
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Affiliation(s)
| | | | - Nikolaas Vantomme
- Department of Neurosurgery, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Melissa Cambron
- Department of Neurology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Jan W Casselman
- Department of Radiology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
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2
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Halalmeh DR, Asad MY, Atallah OA, Sbeih AI, Alrashdan M, Richardson AM, Moisi MD, Sbeih IA. Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report. World Neurosurg 2023; 179:204-215.e4. [PMID: 37652133 DOI: 10.1016/j.wneu.2023.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | - Mahmoud Y Asad
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Omar A Atallah
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Angela M Richardson
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
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Eguiluz-Melendez A, Sangrador-Deitos MV, Díaz-Bello S, Degollado-García J, Tena-Suck ML, Valencia-Ramos C, Marian-Magana R, Gómez-Amador JL. Microsurgical Resection of a Giant Trochlear Nerve Schwannoma: 2-Dimensional Operative Video. World Neurosurg 2023; 176:161. [PMID: 37169071 DOI: 10.1016/j.wneu.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
We present the case of a 17-year-old male, who complained of a 1-year onset of pulsatile headache, dysphagia, speech changes, and emotional lability. Neuroimaging revealed a large left-sided contrast-enhancing tumor located at the infratentorial space consistent with a large trochlear nerve schwannoma. The tumor was compressing the brainstem, obstructing the outflow of the third and lateral ventricles causing hydrocephalus, and disturbing the cortico-bulbar pathways bilaterally leading to the diagnosis of pseudobulbar palsy. After the patient consented the surgical procedure, he was operated through a subtemporal transtentorial approach placed in the lateral position. A lumbar drain was used for brain relaxation during the procedure and image guidance to define the limits of surgical exposure. A microsurgical technique was used, aiming to preserve the cranial nerves and the vascular structures running through the perimesencephalic cisterns. Gross total resection was achieved and clinical course remained uneventful aside from a transient third nerve palsy. Symptoms improved and the three-month follow-up revealed an almost complete function of the oculomotor nerve (Video 1). Trochlear nerve schwannomas are the rarest variety of the cranial nerve schwannomas. Depending on tumor size, clinical and neuroimaging signs of mass effect and brainstem compression, treatment can be observation, microsurgical resection through cranial base approaches or radiosurgery.1-5.
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Affiliation(s)
- Aldo Eguiluz-Melendez
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Marcos V Sangrador-Deitos
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.
| | - Sergio Díaz-Bello
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Javier Degollado-García
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Martha L Tena-Suck
- Neuropathology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Cristopher Valencia-Ramos
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Ricardo Marian-Magana
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - Juan L Gómez-Amador
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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4
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Lei J, Li Y, Wan X, Wang J, You C, Zhao K, Niu H. Hemorrhagic schwannoma of the trochlear nerve: Case report and a review of the literature. Front Oncol 2023; 12:1097155. [PMID: 36713505 PMCID: PMC9880228 DOI: 10.3389/fonc.2022.1097155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Background Schwannomas of the trochlear nerve with the absence of systemic neurofibromatosis are considerably uncommon, especially complicated by intra-tumoral hemorrhage. Due to the lack of typical clinical manifestations and imaging findings, a definite diagnosis of trochlear schwannomas before surgery is particularly difficult. Case presentation We report the case of a 64-year-old female patient who presented with a unilaterally intermittent headache of 2-month duration and without a remarkable neurological deficit at admission. Imaging studies revealed a well-demarcated cystic-solid lesion with mixed signals beside the brainstem and suprasellar cisterna. The patient underwent a surgical operation with total resection of the tumor by a subtemporal surgical approach. The tumor was intraoperatively found to originate from the trochlear nerve and was pathologically confirmed as a hemorrhagic schwannoma with cystic degeneration. Conclusions We describe this case in detail and conduct a concomitant survey of the literature, summarizing the clinical presentations, radiological features, surgical treatment, and the possible mechanisms of hemorrhage in relevance to trochlear nerve schwannoma.
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Affiliation(s)
| | | | | | | | | | - Kai Zhao
- *Correspondence: Kai Zhao, ; Hongquan Niu,
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5
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Gerganov V, Petrov M, Sakelarova T. Schwannomas of Brain and Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:331-362. [PMID: 37452944 DOI: 10.1007/978-3-031-23705-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Schwannomas are benign tumors originating from the Schwann cells of cranial or spinal nerves. The most common cranial schwannomas originate from the eight cranial nervevestibular schwannomas (VS). VS account for 6-8% of all intracranial tumors, 25-33% of the tumors localized in the posterior cranial fossa, and 80-94% of the tumors in the cerebellopontine angle (CPA). Schwannomas of other cranial nerves/trigeminal, facial, and schwannomas of the lower cranial nerves/are much less frequent. According to the World Health Organization (WHO), intracranial and intraspinal schwannomas are classified as Grade I. Some VS are found incidentally, but most present with hearing loss (95%), tinnitus (63%), disequilibrium (61%), or headache (32%). The neurological symptoms of VSs are mainly due to compression on the surrounding structures, such as the cranial nerves and vessels, or the brainstem. The gold standard for the imaging diagnosis of VS is MRI scan. The optimal management of VSs remains controversial. There are three main management options-conservative treatment or "watch-and-wait" policy, surgical treatment, and radiotherapy in all its variations. Currently, surgery of VS is not merely a life-saving procedure. The functional outcome of surgery and the quality of life become issues of major importance. The most appropriate surgical approach for each patient should be considered according to some criteria including indications, risk-benefit ratio, and prognosis of each patient. The approaches to the CPA and VS removal are generally divided in posterior and lateral. The retrosigmoid suboccipital approach is a safe and simple approach, and it is favored for VS surgery in most neurosurgical centers. Radiosurgery is becoming more and more available nowadays and is established as one of the main treatment modalities in VS management. Radiosurgery (SRS) is performed with either Gamma knife, Cyber knife, or linear accelerator. Larger tumors are being increasingly frequently managed with combined surgery and radiosurgery. The main goal of VS management is preservation of neurological function - facial nerve function, hearing, etc. The reported recurrence rate after microsurgical tumor removal is 0.5-5%. Postoperative follow-up imaging is essential to diagnose any recurrence.
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Affiliation(s)
- Venelin Gerganov
- International Neuroscience Institute, Hannover, Germany
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria
| | - Mihail Petrov
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria.
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6
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Ozoner B, Gungor A, Ture H, Ture U. Surgical Treatment of Trochlear Nerve Schwannomas: Case Series and Systematic Review. World Neurosurg 2022; 162:e288-e300. [PMID: 35276398 DOI: 10.1016/j.wneu.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. No consensus has yet been made for surgical intervention because of the low number of reported cases of trochlear nerve schwannomas. This study comprises a systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas. METHODS Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature and presented patients of any age who underwent surgical treatment for trochlear schwannoma. Data extracted from the included studies were combined with our experience. RESULTS Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after our experience was added. The most common symptoms were diplopia (62.2%), headache (46.7%), and motor weakness (37.8%). Mean age during the diagnosis was 45.1 years. Although the subtemporal transtentorial approach (n = 14) is the most preferred method, its application has decreased in recent years. In the last decade, the lateral suboccipital approach (n = 11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of patients. The probability of neurologic deficit was not statistically associated with tumor volume (P = 0.914), location (P = 0.669), or resection rate (P = 0.554). CONCLUSIONS Although trochlear schwannomas are rare and their treatment involves challenges, total resection with the proper approach provides the most desirable results.
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Affiliation(s)
- Baris Ozoner
- Department of Neurosurgery, Kartal Dr. Lutfi Kirdar Research and Education Hospital, Istanbul, Turkey; Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Abuzer Gungor
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Hatice Ture
- Department of Anesthesiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ugur Ture
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
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7
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Froines CP, Van Brummen AJ, Francis CE. A Case of Isolated Bilateral Trochlear Nerve Schwannomas. J Neuroophthalmol 2022; 42:e394-e395. [PMID: 34348363 DOI: 10.1097/wno.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Colin P Froines
- Departments of Ophthalmology (CPF, AJV, CEF) and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle, Washington
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8
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Part I: oculomotor and other rare non-vestibular schwannomas (I, II, III, IV, VI). Acta Neurochir (Wien) 2022; 164:285-297. [PMID: 34755208 DOI: 10.1007/s00701-021-05048-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogeneous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the first of a three-part series describing non-vestibular schwannomas (I, II, III, IV, VI). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management of these patients is complex, and for those which are symptomatic tumours, the paradigm is shifting towards the compromise between function preservation and progression-free survival.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | | | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Pierre-Hugues Roche
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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9
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Less common extracerebral tumors. PROGRESS IN BRAIN RESEARCH 2022; 268:279-302. [PMID: 35074086 DOI: 10.1016/bs.pbr.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter examines the results of GKNS on a variety of extraparenchymal skull base tumors some benign and some malignant. For the benign tumors there is good evidence on the effectiveness of the method for pretty much all diagnoses. For malignant extraparenchymal tumors the results are more limited and GKNS only has a supportive role in these lesions.
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10
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Langlois AM, Iorio-Morin C, Faramand A, Niranjan A, Lunsford LD, Mohammed N, Sheehan JP, Liščák R, Urgošík D, Kondziolka D, Lee CC, Yang HC, Atik AF, Mathieu D. Outcomes after stereotactic radiosurgery for schwannomas of the oculomotor, trochlear, and abducens nerves. J Neurosurg 2021; 135:1044-1050. [PMID: 33482633 DOI: 10.3171/2020.8.jns20887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial nerve (CN) schwannomas are intracranial tumors that are commonly managed by stereotactic radiosurgery (SRS). There is a large body of literature supporting the use of SRS for vestibular schwannomas. Schwannomas of the oculomotor nerves (CNs III, IV, and VI) are rare skull base tumors, occurring close to the brainstem and often involving the cavernous sinus. Resection can cause significant morbidity, including loss of nerve function. As for other schwannomas, SRS can be used to manage these tumors, but only a handful of cases have been published so far, often among reports of other uncommon schwannoma locations. METHODS The goal of this study was to collect retrospective multicenter data on tumor control, clinical evolution, and morbidity after SRS. This study was performed through the International Radiosurgery Research Foundation. Patients managed with single-session SRS for an oculomotor cranial nerve schwannoma (CN III, IV, or VI) were included. The diagnosis was based on diplopia or ptosis as the main presenting symptom and anatomical location on the trajectory of the presumed cranial nerve of origin, or prior resection confirming diagnosis. Demographic, SRS dose planning, clinical, and imaging data were collected from chart review of the treated patients. Chi-square and Kaplan-Meier analyses were performed. RESULTS Seven institutions submitted data for a total of 25 patients. The median follow-up time was 41 months. The median age at the time of treatment was 52 years. There were 11 CN III schwannomas, 11 CN IV schwannomas, and 3 CN VI schwannomas. The median target volume was 0.74 cm3, and the median marginal dose delivered was 12.5 Gy. After SRS, only 2 patients (including the only patient with neurofibromatosis type 2) had continued tumor growth. Crude local control was 92% (23/25), and the 10-year actuarial control was 86%. Diplopia improved in the majority of patients (11/21), and only 3 had worsening following SRS, 2 of whom also had worsened ptosis, both in the context of tumor progression. CONCLUSIONS SRS for schwannomas of the oculomotor, trochlear, and abducens nerves is effective and provides tumor control rates similar to those for other cranial nerve schwannomas. SRS allows improvement of diplopia in the majority of patients. SRS should therefore be considered as a first-line treatment option for oculomotor nerve schwannomas.
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Affiliation(s)
- Anne-Marie Langlois
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Christian Iorio-Morin
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Andrew Faramand
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Nasser Mohammed
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Roman Liščák
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Dušan Urgošík
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Douglas Kondziolka
- 5Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Cheng-Chia Lee
- 6Department of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan; and
| | - Huai-Che Yang
- 6Department of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan; and
| | - Ahmet F Atik
- 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Mathieu
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
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11
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Gupta A, Lee ECH, Kelly HR, Chen RC. Clinical and Imaging Manifestations of Trochlear Nerve Schwannomas-A Case Series. J Neuroophthalmol 2021; 41:e339-e342. [PMID: 32956233 DOI: 10.1097/wno.0000000000001059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Arvind Gupta
- Department of Opthalmology, Counties Manukau DHB and Auckland DHB (AG), Auckland, New Zealand; Department of Diagnostic Radiology, SingHealth Institution (ELCH, RCC), Singapore ; Massachusetts Eye and Ear (HRK), Boston, Massachusetts; Department of Diagnostic Radiology, Massachusetts General Hospital (HRK), Harvard Medical School, Boston, Massachusetts; and Duke Medical School (RCC), Singapore
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12
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Suárez C, López F, Mendenhall WM, Andreasen S, Mikkelsen LH, Langendijk JA, Bondi S, Rodrigo JP, Bäck L, Mäkitie AA, Fernández-Alvarez V, Coca-Pelaz A, Smee R, Rinaldo A, Ferlito A. Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas. Cancer Manag Res 2021; 13:463-478. [PMID: 33500660 PMCID: PMC7822088 DOI: 10.2147/cmar.s287410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/30/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5–10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stefano Bondi
- Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | | | - Andrés Coca-Pelaz
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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13
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Alhussain ZM, Alharbi SK, Farrash F. Abducens nerve schwannoma of the cavernous sinus: A case report and literature review. Surg Neurol Int 2020; 11:402. [PMID: 33365165 PMCID: PMC7749956 DOI: 10.25259/sni_362_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Schwannomas of the abducens nerve are a rare pathology and are encountered less within the cavernous sinus. We describe a case of sixth cranial nerve schwannoma, in the cavernous sinus. Case Description: A 50-year-old lady, presented with 2 years history of double vision and left facial numbness that started 6 months before presentation, found to have hyperintense lobulated mass at the left cavernous sinus extending into Meckel’s cave with bony remodeling on magnetic resonance imaging. She underwent left frontotemporal craniotomy, combined extra-intradural approach, gross total resection. She had a gradual recovery of the sixth cranial nerve function. Conclusion: Abducens nerve schwannoma of the cavernous sinus is a rare and challenging tumor. However amenable to surgical intervention with favorable neurological outcome.
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Affiliation(s)
- Zeyad M Alhussain
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shatha K Alharbi
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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14
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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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15
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Imran Zaidi SM, Naik P, Ahmed SK. Abducens Nerve Schwannoma: First Case to Be Treated With an Expanded Endonasal Approach. EAR, NOSE & THROAT JOURNAL 2020; 101:NP190-NP192. [PMID: 32955349 DOI: 10.1177/0145561320960541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abducens nerve schwannomas are incredibly rare, with very few cases being reported previously. Our patient is the first to have been treated through use of an endoscopic endonasal approach. A 61-year-old woman presented with diplopia over a 1-year period. Magnetic resonance imaging identified a 2.8-cm lesion expanding into her right sphenoid sinus. She underwent an endoscopic endonasal approach for histological diagnosis and clearance of the lesion. Intraoperative exploration found the lesion to be originating from Dorello canal. Histological analysis confirmed a benign schwannoma. Following a multidisciplinary case review, we have followed a conservative approach and she remains well on radiological surveillance. In patients presenting with a sixth nerve palsy/paresis and a concomitant sphenoid lesion, clinicians should consider an abducens schwannoma as a possible diagnosis.
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Affiliation(s)
- Syed Mohammad Imran Zaidi
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Paresh Naik
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shahzada K Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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16
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Lock JH, Biousse V, Newman NJ. Trochlear nerve schwannoma: A 22 year follow-up. Clin Exp Ophthalmol 2019; 48:257-258. [PMID: 31648397 DOI: 10.1111/ceo.13664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/08/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Jane H Lock
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
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17
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Prognosis Factor in Oculomotor Schwannoma: A Case of Endoscopic Endonasal Approach and Systematic Review of the Literature. World Neurosurg 2019; 129:72-80. [PMID: 31150851 DOI: 10.1016/j.wneu.2019.05.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report the first case of oculomotor nerve (ON) schwannoma treatment through an endonasal endoscopic approach. We also review the literature to determine prognosis factors of ON function after treatment. METHODS A complete MEDLINE search was undertaken for all articles reporting data for oculomotor schwannoma. We divided the patient population into 2 groups; Group I: patients who conserved or recovered good ON function and Group II: patients with either new, worsening, or unchanged third-nerve palsy at the last available follow-up. We conducted a comparative statistical analysis of data between the 2 groups. RESULTS We identified 55 reported cases of ON schwannoma, all of whom were treated with open transcranial surgery, stereotactic radiosurgery, or observation. There were 22 patients in group I and 33 in group II. At admission, 29 patients had complete oculomotor nerve palsy (34.7% in group I and 67.7% in group II; P = 0.02). Surgical treatment was performed in 36 cases. Radiosurgery was performed in 3 cases. Among patients with good preoperative ON function, 34.6% worsened at last follow-up (26.6% after surgery and 50% with observation; P = 0.03). In total, 31% of patients with total or near-total palsy at admission had an improvement of their ON function (all after surgical resection; P = 0.05). CONCLUSIONS ON function at admission and surgical resection of schwannoma appears to be a predictive factor of favorable prognosis regardless of location and tumor size. The endonasal endoscopic approach can be used to biopsy tumors in cases in which open surgery is considered too risky, such as cavernous sinus schwannomas.
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18
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Fadel HA, El Ahmadieh TY, Plitt AR, Neeley OJ, Johnson Z, Aoun SG, Mohamad O, Timmerman R, Weprin BE. Oculomotor Schwannomas: A Systematic Review and Report of Two Pediatric Cases Treated with Fractionated Cyberknife Stereotactic Radiotherapy. World Neurosurg 2019; 129:487-496. [PMID: 31125775 DOI: 10.1016/j.wneu.2019.05.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Pediatric oculomotor nerve schwannomas are rare and challenging lesions due to the high morbidity associated with surgical intervention and their proximity to critical structures limiting the opportunity for stereotactic radiosurgery. We aim to report and review the novel use of fractionated Cyberknife (Accuray, Inc., Sunnyvale, California, USA) stereotactic radiotherapy in pediatric patients with oculomotor schwannomas. METHODS A systematic review of PubMed, Embase, and Cochrane was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two patients, ages 8 and 10 years, with tumor volumes of 0.1 cm3 and 0.2 cm3, respectively, were treated with fractionated Cyberknife radiotherapy at our institution. A total dose of 45-50 Gy was administered over 25 fractions (1.8-2.0 Gy per fraction) to the 82%-84% isodose line. Serial magnetic resonance imaging was obtained for long-term follow-up (56-58 months). RESULTS We found 14 articles published between 1982 and 2018 that reported a total of 18 pediatric patients with intracranial oculomotor schwannomas. No previously described cases of pediatric intracranial oculomotor schwannomas were treated with radiation therapy. In both of our patients, radiographic tumor control was achieved at a mean follow-up of 57 months, with 1 patient displaying a decrease in tumor volume. Neither patient exhibited any worsening of their presenting symptoms, nor did either patient develop any new neurocognitive deficits following treatment. CONCLUSIONS Fractionated Cyberknife radiotherapy is an effective and well-tolerated treatment option for intracranial oculomotor nerve schwannomas with excellent tumor control rates, similar to surgical and radiosurgical techniques, while sparing critical surrounding structures.
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Affiliation(s)
- Hassan A Fadel
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA.
| | - Aaron R Plitt
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Om J Neeley
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Zachary Johnson
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Osama Mohamad
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas, USA
| | - Robert Timmerman
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA; Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas, USA
| | - Bradley E Weprin
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA; Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas, USA
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19
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Abstract
Trochlear schwannomas typically present with diplopia and are extremely rare benign intracranial neoplasms that require the combined expertise of neurotologists and neurosurgeons for surgical excision. A combined petrosal approach offers a surgical route for removal of growing and/or symptomatic tumors. A study of a trochlear nerve schwannoma that demonstrated rapid growth but was otherwise asymptomatic was presented in this study.
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