1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Umana GE, Passanisi M, Chaurasia B, Scalia G. Incidental craniovertebral junction schwannoma: Surgical or radiosurgical management? Clin Case Rep 2023; 11:e7616. [PMID: 37384236 PMCID: PMC10293573 DOI: 10.1002/ccr3.7616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Craniovertebral junction (CVJ) schwannomas are rare tumors, showing direct involvement of the atlanto-occipital and atlanto-axial joints. Microsurgical removal is the standard of care to improve symptoms and local control, but stereotactic radiosurgery (SRS) is an option. Both, surgery, and SRS, may show risks of severe complications. A 41-year-old male was referred to our department after incidental finding of a right-sided C1 tumor. A CT angiogram with 3D reconstructions showed the close relationship between the tumor and the right vertebral artery (VA). A post-contrast enhancement MRI revealed the presence of an extradural mass, sited at the level of the CVJ, mainly at the level of the right articular mass of C1. After multidisciplinary assessment, involving the gamma-knife and neurosurgical teams, we performed a microsurgical resection of the tumor. Histology confirmed the diagnosis of schwannoma. At 1 year follow-up the patient is stable, with no recurrence of the tumor. CVJ schwannoma's current standard of care is surgical resection, but longitudinal studies are required, and should promoted promptly since the recent introduction of the new version of GKSRS that allow the treatment of CVJ's lesions.
Collapse
Affiliation(s)
| | - Maurizio Passanisi
- Department of Neurosurgery, Trauma Center, Gamma Knife CenterCannizzaro HospitalCataniaItaly
| | | | - Gianluca Scalia
- Department of Head and Neck Surgery, Neurosurgery UnitGaribaldi HospitalCataniaItaly
| |
Collapse
|
4
|
Dabhi N, Pikis S, Mantziaris G, Tripathi M, Warnick R, Peker S, Samanci Y, Berger A, Bernstein K, Kondziolka D, Niranjan A, Lunsford LD, Sheehan JP. Stereotactic radiosurgery for the treatment of hypoglossal schwannoma: a multi-institutional retrospective study. Acta Neurochir (Wien) 2022; 164:2473-2481. [PMID: 35347448 DOI: 10.1007/s00701-022-05187-w] [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: 01/30/2022] [Accepted: 03/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical removal has been performed as the first line treatment for symptomatic or enlarging hypoglossal schwannomas (HS). Stereotactic radiosurgery (SRS) offers a minimally invasive approach that may afford long-term tumor control for patients with HS particularly those who refuse or are unfit for surgery. This study evaluates outcomes after SRS performed for both newly diagnosed and residual tumors after incomplete resection. METHODS This retrospective, multi-institutional study involved patients treated with adjuvant or primary SRS for HS. The study end-points included local tumor response, clinical outcomes, and procedure-related complications. All the patients had Gamma Knife SRS. RESULTS The cohort included 12 patients (five females), median age at SRS 49.5 years (range, 37-76)]. The median tumor target volume was 5.9 cm3 (range, 0.7-27.23). At median imaging follow-up of 37 months (range, 6-153), tumor control was achieved in 11 patients. Tumor enlargement that was managed with surgical resection was noted at the 6-month follow-up in one patient. At median clinical follow-up of 30.5 months (range, 6-157), stability, or improvement of all pre-SRS signs and symptoms was noted in nine patients. Two patients experienced worsening of at least one pre-existing symptoms or sign. New-onset trapezius weakness was noted in one patient and tongue atrophy in two patients. CONCLUSION Single-fraction SRS appears to be a safe and effective upfront and adjuvant treatment option for HS. SRS may be recommended as an alternative to surgery for patients presenting with HS or as an adjuvant treatment following subtotal resection and at HS recurrence.
Collapse
Affiliation(s)
- Nisha Dabhi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ronald Warnick
- Gamma Knife Center, The Jewish Hospital, Cincinnati, OH, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Assaf Berger
- Department of Neurosurgery, New York University Langone, New York, NY, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone, New York, NY, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone, New York, NY, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.
| |
Collapse
|
5
|
Palmisciano P, Ferini G, Watanabe G, Conching A, Ogasawara C, Scalia G, Bin-Alamer O, Haider AS, Passanisi M, Maugeri R, Hoz SS, Baldoncini M, Campero A, Salvati M, Cohen-Gadol AA, Umana GE. Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review. Curr Oncol 2022; 29:4842-4855. [PMID: 35877244 PMCID: PMC9319499 DOI: 10.3390/curroncol29070384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.
Collapse
Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Gina Watanabe
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy;
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maurizio Passanisi
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Experimental Biomedicine & Clinical Neuroscience, Azienda Ospedaliera Universitaria Policlinico, 90127 Palermo, Italy;
| | - Samer S. Hoz
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina;
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Maurizio Salvati
- Department of Neurosurgery, Neuromed, IRCCS, Sapienza University of Rome, 86077 Pozzilli, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Giuseppe E. Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
- Correspondence: ; Tel.: +39-38-0332-5479
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Dabhi N, Pikis S, Sheehan J. Stereotactic radiosurgery for hypoglossal schwannoma. BMJ Case Rep 2022; 15:e244849. [PMID: 35410946 PMCID: PMC9003595 DOI: 10.1136/bcr-2021-244849] [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] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Hypoglossal schwannomas (HS) are extremely rare neoplasms. Surgical resection has historically been the treatment of choice but carries a significant risk of postoperative neurological deficits and mortality. Stereotactic radiosurgery (SRS) is a minimally invasive approach that may afford long-term tumour growth. However, literature to determine the safety and effectiveness of SRS in the treatment of HS is scarce. We report on a patient who presented with progressive headache and dysphagia as well as tongue deviation to the left, due to a space-occupying lesion, consistent on brain MRI with a left HS. Primary SRS using a prescription dose of 12 Gy in a single fraction was used to treat the tumour without complications. By last follow-up, the tumour regressed, and the patient's symptoms improved. Our case shows that radiosurgery can be safe and effective for the management of HS.
Collapse
Affiliation(s)
- Nisha Dabhi
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jason Sheehan
- University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
8
|
Zhu JE, Chen YC, Yu SY, Xu HX. The first experience of ultrasound-guided percutaneous microwave ablation for extracranial schwannoma of the cervical vagus nerve in carotid space and treatment response evaluation with contrast-enhanced imaging. Clin Hemorheol Microcirc 2021; 80:437-446. [PMID: 34864650 DOI: 10.3233/ch-211301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schwannoma is a benign tumor that originates from Schwann cells in the nerve sheathing of cranial, other peripheral, or autonomic nerves. Patients often present with painless mass as the chief complaint. The main symptoms of this tumor are related to its size and specific nerve origin. At present, the pretreatment diagnosis is mainly made by ultrasound, CT, MR, or biopsy, and the main treatment is surgical resection. We reported a new treatment method for cervical schwannoma in a 65-year-old woman with a history of non-small cell lung cancer (NSCLC). When the patient's neck mass was initially found with hoarseness and severe cough, it was considered as cervical lymph node metastasis of lung cancer due to her medical history. And she was diagnosed with schwannoma by core-needle biopsy after chemotherapy failed and the tumor shrank after the radiotherapy with no improvement of the clinical symptoms. After considering the physical condition, the patients were treated in our department for minimal invasiveness treatment. The patient was definitively diagnosed with cervical vagus schwannoma and was treated with ultrasound-guided microwave ablation of schwannoma under general anesthesia with systematic evaluation and improved preoperative examination. Her condition was stable, and the symptoms of severe cough disappeared after anesthesia resuscitation and the ablation. The tumor continued to shrink after the operation with no recurrence of cough symptoms. Ultrasound-guided percutaneous microwave ablation (MWA) for cervical vagus schwannomas might be a minimally invasive, effective, and relatively safe alternative to conventional treatment for those patients with severe symptoms.
Collapse
Affiliation(s)
- Jing-E Zhu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yun-Chao Chen
- Department of Medical Ultrasound, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Song-Yuan Yu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| |
Collapse
|
9
|
Douglas VP, Flores C, Douglas KA, Strominger MB, Kasper E, Torun N. Oculomotor nerve schwannoma: case series and literature review. Surv Ophthalmol 2021; 67:1160-1174. [PMID: 34813853 DOI: 10.1016/j.survophthal.2021.11.008] [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: 05/13/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
Abstract
Oculomotor nerve schwannomas are rare benign cranial nerve tumors. There are only a limited number of reports on this pathology in the literature, and there are currently no established management guidelines that aid providers in deciding on surgical versus nonsurgical management. We assess the published literature on the topic to identify indications for treatment as well as outcome measures (e.g., local control rates, survival rates, and complication rates) that have been reported as associated with the various treatment modalities. We attempt to develop an algorithm for evaluation and treatment of oculomotor nerve schwannomas in order to establish consensus on how these tumors should be treated.
Collapse
Affiliation(s)
- Vivian Paraskevi Douglas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Konstantinos Aa Douglas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Ekkehard Kasper
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, USA
| | - Nurhan Torun
- Division of Ophthalmology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
10
|
Kawashima M, Hasegawa H, Shin M, Shinya Y, Saito N. Intratumoral hemorrhage in jugular foramen schwannoma after stereotactic radiosurgery: A case report. Surg Neurol Int 2021; 12:479. [PMID: 34754529 PMCID: PMC8571193 DOI: 10.25259/sni_550_2021] [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: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Clinically significant intratumoral hemorrhage is a rare complication of stereotactic radiosurgery (SRS) for benign tumors. Case Description: Here, we present the case of a 64-year-old man who underwent SRS for a relatively large dumbbell-shaped left jugular foramen schwannoma (JFS) and thereafter developed intratumoral hemorrhage. On post-SRS day 3, he developed lower cranial nerve palsies with radiographically evident tumor expansion. His neurological conditions had gradually improved thereafter; however, he suddenly developed headache, dizziness, and mild hearing deterioration at 7 months due to intratumoral hemorrhage. We managed the patient conservatively, and eventually, his symptoms improved except for slight ataxia and hearing deterioration. Follow-up images at 4 years from SRS demonstrated significant tumor shrinkage. This is the first report describing intratumoral hemorrhage after SRS for JFS. Conclusion: Transient expansion of the tumor and subsequent venous stasis around the tumor may have played a role in the hemorrhage. Intratumoral hemorrhage should be considered as a rare, but potential complication of SRS for JFSs.
Collapse
Affiliation(s)
- Mariko Kawashima
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
11
|
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.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Mariniello G, de Divitiis O, Caranci F, Dones F, Maiuri F. Parasellar Schwannomas: Extradural vs Extra-Intradural Surgical Approach. Oper Neurosurg (Hagerstown) 2019; 14:627-638. [PMID: 28961901 DOI: 10.1093/ons/opx174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/12/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schwannomas of the parasellar region may arise from the trigeminal, oculomotor, trochlear, and abducens nerves. OBJECTIVE To define the tumor origin, location, and dural relationship (extradural vs extra-intradural vs cisternal) on preoperative magnetic resonance imaging (MRI), in order to plan the best surgical approach (purely extradural vs extra-intradural). METHODS Twenty-four patients with parasellar schwannomas who underwent surgery were retrospectively analyzed. Twenty arose from the trigeminal nerve (7 intracavernous and 13 within the Meckel's cave), 3 from the oculomotor nerve, and 1 from the abducens nerve. The preoperative identification of the tumor location (extradural vs extra-intradural vs cisternal) and the nerve of origin was defined on MR sequences. All patients were operated on through a pterional approach (extradural or extra-intradural route). RESULTS The tumor location was correctly defined on MRI in 22 out of 24 cases (92%) and the nerve of origin in 22 (92%). An extradural approach without intradural exploration was performed in all 5 intracavernous trigeminal schwannomas, in 11 out of 13 of the Meckel's cave, and in 2 schwannomas of the oculomotor nerve. Two schwannomas of the Meckel's cave with transgression of the medial dural wall, 1 of the oculomotor nerve, and the abducens nerve schwannoma required an extra-intradural approach. Complete tumor resection was obtained in 19 out of 24 cases (80%). CONCLUSION The pterional extradural approach is sufficient for Dolenc type I and II trigeminal schwannomas, excepting for those transgressing the inner dural layer. Schwannomas of the oculomotor and abducens nerves with cisternal location require an extradural-intradural approach.
Collapse
Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Oreste de Divitiis
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Flavia Dones
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| |
Collapse
|
15
|
Tarabay A, Rocca A, Maeder P, Simonin A, Messerer M, Daniel RT. Extra-Axial Cavernoma of the Cerebellopontine Angle: A Case Study and Review of Literature. World Neurosurg 2019; 128:415-421. [DOI: 10.1016/j.wneu.2019.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Abstract
Objective: Gamma Knife radiosurgery (GKRS) has been established as an effective and safe treatment for intracranial Schwannoma. However, communicating hydrocephalus can occur after GKRS. The risk factors of this disorder are not yet fully understood. The objective of the study was to assess potential risk factors for hydrocephalus after GKRS. Methods: We retrospectively reviewed the medical radiosurgical records of 92 patients who underwent GKRS to treat intracranial Schwannoma and developed communicating hydrocephalus. The following parameters were analyzed as potential risk factors for hydrocephalus after GKRS: age, sex, target volume, irradiation dose, prior tumor resection, treatment technique, tumor enhancement pattern, and protein level of cerebrospinal fluid (CSF) after GKRS. Results: Of the 92 patients, eight of them developed communicating hydrocephalus. Target volume and tumor enhancement pattern, and protein level of CSF ware associated with the development of hydrocephalus. Conclusion: In particular, patients with intracranial Schwannomas with large tumor size, ring enhancement patterns, and high protein level of CSF should be carefully observed.
Collapse
Affiliation(s)
- Yu Shimizu
- Department of Neurosurgery, Kanazawa Medical Center, Kanazawa, Japan.,Department of Neurosurgery, Toyama City Hospital, Toyama, Japan
| | - Tadao Miyamori
- Department of Neurosurgery, Toyama City Hospital, Toyama, Japan
| | - Jun Yamano
- Department of Neurosurgery, Toyama City Hospital, Toyama, Japan
| |
Collapse
|
18
|
Spina A, Boari N, Gagliardi F, Bailo M, Del Vecchio A, Bolognesi A, Mortini P. Gamma Knife radiosurgery for glomus tumors: Long-term results in a series of 30 patients. Head Neck 2018; 40:2677-2684. [PMID: 30456888 DOI: 10.1002/hed.25517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/10/2018] [Accepted: 09/28/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Glomus tumors are rare and benign hypervascular tumors. Surgery represented the mainstay of their treatment, even if it has been associated with high morbidity and mortality rates. Recently, the treatment shifted to a multimodal approach and Gamma Knife radiosurgery represents one of the treatment options. METHODS Authors retrospectively analyzed the clinical and radiological outcome of a series of patients who underwent Gamma Knife radiosurgery for glomus tumors. RESULTS Thirty patients underwent Gamma Knife radiosurgery. Mean tumor volume was 7.69 cc (range 0.36-24.6). Mean tumor margin dose was 16 Gy (range 13-18). Median follow-up was of 91 months (mean 90; range 11-172). Overall clinical control rate was 100%; overall volumetric tumor control rate was 96.6%. Patients' and tumors' characteristics, treatment data, and outcome have been analyzed. CONCLUSION Gamma Knife radiosurgery represents a safe and effective treatment for glomus tumors. Longer follow-up and larger cohort studies are needed to definitively outline the role of Gamma Knife radiosurgery for glomus tumors.
Collapse
Affiliation(s)
- Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Service of Medical Physics, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Bolognesi
- Service of Radiation Oncology, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| |
Collapse
|
19
|
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]
|
20
|
Heda S, Karthik DK, Rao ES, Deshpande A. Hypoglossal canal schwannoma causing isolated left 12th cranial nerve palsy. BMJ Case Rep 2018; 2018:bcr-2018-225544. [PMID: 30389733 DOI: 10.1136/bcr-2018-225544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 40-year-old woman presented with insidious onset, gradually progressive dysarthria and inability to manoeuvre bolus of food in her mouth while eating. The duration of her symptoms was 3 months. On evaluation, the left half of her tongue was wasted. The tongue deviated to the left on protrusion. There were no clinical features suggestive of involvement of the ipsilateral 9th, 10th or 11th cranial nerves. MRI of the brain showed a large, fusiform lesion in the left hypoglossal canal, extending into the jugular canal. The lesion was surgically excised and found to be a schwannoma.
Collapse
Affiliation(s)
- Shruti Heda
- Department of Pathology, Max Care Hospital, Warangal, Telangana, India
| | | | | | - Anirudda Deshpande
- Department of Neurology, Vinayaka Neuro Multispeciality Clinic, Warangal, Telangana, India
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Comps JN, Tuleasca C, Goncalves-Matoso B, Schiappacasse L, Marguet M, Levivier M. Upfront Gamma Knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review. Acta Neurochir (Wien) 2018; 160:987-996. [PMID: 29492656 DOI: 10.1007/s00701-018-3503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Facial nerve schwannomas are rare tumors and account for less than 2% of intracranial neurinomas, despite being the most common tumors of the facial nerve. The optimal management is currently under debate and includes observation, microsurgical resection, radiosurgery (RS), and fractionated radiotherapy. Radiosurgery might be a valuable alternative, as a minimally invasive technique, in symptomatic patients and/or presenting tumor growth. METHODS We review our series of four consecutive cases, treated with Gamma Knife surgery (GKS) between July 2010 and July 2017 in Lausanne University Hospital, Switzerland. Clinical and dosimetric parameters were assessed. Radiosurgery was performed using Leksell Gamma Knife Perfexion. We additionally performed a systematic review, which included 23 articles and 193 treated patients from the current literrature. RESULTS The mean age at the time of the GKS was 44.25 years (median 43.5, range 34-56). Mean follow-up period was 31.8 months (median 36, range 3-60). Two cases presented with facial palsy and other two with hemifacial spasm. Pretherapeutically, House-Brackmann (HB) grade was II for one case, III for two, and VI for one. The mean gross tumor volume (GTV) was 0.406 ml (median 0.470 ml, range 0.030-0.638 ml). The mean marginal prescribed dose was 12 Gy at the mean 54% isodose line (median 50%, range 50-70). The mean prescription isodose volume (PIV) was 0.510 ml (median 0.596 ml, range 0.052-0.805 ml). The mean dose received by the cochlea was 4.2 Gy (median 4.1 Gy, range 0.1-10). One patient benefited from a staged-volume GKS. At last follow-up, tumor volume was stable in one and decreased in three cases. Facial palsy remained stable in two patients (one HB II and one HB III) and improved in two (from HB III to II and from HB VI to HB III). Regarding hemifacial spasm, both patients presenting one pretherapeutically had a decrease in its frequency and intensity after GKS. All patients kept stable Gardner-Robertson class 1 at last follow-up. CONCLUSION In our experience, RS and particularly GKS, using standard, yet low doses of radiation, appear to be a safe and effective therapeutic option in the management of these rare tumors. The results as from our systematic review are also encouraging with satisfactory rates of clinical stabilization and/or improvement and high rate of tumor control. Complications are infrequent and mostly transient.
Collapse
Affiliation(s)
- Jean-Nicolas Comps
- Neurosciences Department, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland
| | - Constantin Tuleasca
- Neurosciences Department, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Swiss Federal Institute of Technology, Signal Processing Laboratory (LTS5), Lausanne, Switzerland.
| | | | - Luis Schiappacasse
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Maud Marguet
- Institute of Radiation Physics Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Neurosciences Department, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
23
|
Abstract
OBJECTIVES We analyzed the outcomes of patients with benign nonacoustic schwannomas treated with fractionated radiation therapy (RT). METHODS Between October 1987 and March 2013, 11 patients with benign nonacoustic schwannomas diagnosed radiographically (n=3) or pathologically (n=8) were treated with fractionated RT with curative intent at the University of Florida. We reviewed patients' medical records to assess outcomes and toxicities from treatment. RESULTS The median follow-up for all patients was 8.2 years (range, 2.2 to 22.7 y) and 8 years for all living patients (range, 2.2 to 22.7 y). Of the 11 patients included in the analysis, 8 (73%) were treated solely with RT, 1 (9%) was treated with postoperative RT after subtotal resection, and 2 (18%) were treated with postoperative RT after recurrence following initial surgical resection. The 5-year overall survival, disease-free survival, and local control rates were 100%. There were no grade 2 to 5 treatment toxicities. CONCLUSIONS RT for benign nonacoustic schwannoma may be effective when used alone or in addition to surgery. Irradiation should be considered in patients for whom resection is likely to result in one or more neurological deficits. Fractionated RT to a total dose of 50 Gy provides excellent local control and minimal morbidity.
Collapse
|
24
|
Radiosurgery in trochlear and abducens nerve schwannomas: case series and systematic review. Acta Neurochir (Wien) 2017; 159:2409-2418. [PMID: 29022157 DOI: 10.1007/s00701-017-3348-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Schwannomas involving the occulomotor cranial nerves (CNs; III, IV and VI), can be disabling, due to the associated diplopia and decreased quality of life and are extremely rare. We evaluated the role of Gamma Knife surgery (GKS) in these cases. METHODS Five patients with CN IV and VI schwannomas (three and two, respectively) were treated in Lausanne University Hospital between 2010 and 2015. Four benefitted from upfront GKS and one from a combined approach (planned subtotal resection followed by GKS), due to a large preoperative tumour volume (size, 3 × 2 × 2.5 cm; volume, 7.9 ml), with symptomatic mass effect and oedema, as well as an entrapement cyst at the brainstem interface, in a young patient. Neuro-ophtalmological evaluation was performed at baseline and during each follow-up time-point. A systematic literature review is presented and compared to the present report. RESULTS The mean follow-up was 44.4 months (12-54). Initial clinical presentation was diplopia in four cases and cavernous sinus syndrome in one. The marginal dose was 12 Gy in all cases. The mean target volume was 1.51 cm3 (0.086-5.8). The mean prescription isodose volume (PIV) was 1.71 cm3 (0.131-6.7). At last follow-up, all patients presented with disappearance of the baseline symptoms. Tumour control was achieved in 100%, with decrease in volume in all cases. The systematic review analysed 11 peer-reviewed studies, with a total of 35 patients. For uniformly reported CN VI, the mean marginal radiation dose ranged between 12 and 12.5 Gy, with disappearance of symptoms in 12.5%, improvement in 31.25%, stabilisation in 6.25%, worsening in 12.5%. Tumour volume decreased in all cases. CONCLUSIONS Our data suggest that first intention GKS is a safe and effective option for patients with small to medium size oculomotor schwannomas, providing a high rate of clinical alleviation and tumour control. When the initial tumour volume is too large for first intention GKS, a combined approach with planned subtotal resection followed by GKS can be performed, with favourable and comparable outcomes as in upfront GKS.
Collapse
|
25
|
Sato Y, Imanishi Y, Tomita T, Ozawa H, Sakamoto K, Fujii R, Shigetomi S, Habu N, Otsuka K, Watanabe Y, Sekimizu M, Ogawa K. Clinical diagnosis and treatment outcomes for parapharyngeal space schwannomas: A single-institution review of 21 cases. Head Neck 2017; 40:569-576. [DOI: 10.1002/hed.25021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/16/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Yoichiro Sato
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
- Department of Otorhinolaryngology - Head and Neck Surgery; Kawasaki Municipal Kawasaki Hospital; Kawasaki Kanagawa Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
- Department of Otorhinolaryngology - Head and Neck Surgery; Kawasaki Municipal Kawasaki Hospital; Kawasaki Kanagawa Japan
| | - Toshiki Tomita
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
| | - Koji Sakamoto
- Department of Otorhinolaryngology; Saiseikai Utsunomiya Hospital; Utsunomiya Tochigi Japan
| | - Ryoichi Fujii
- Department of Otorhinolaryngology; Saiseikai Yokohamashi Nanbu Hospital; Yokohama Kanagawa Japan
| | - Seiji Shigetomi
- Department of Otorhinolaryngology; Yokohama Municipal Citizen's Hospital; Yokohama Kanagawa Japan
| | - Noboru Habu
- Department of Otorhinolaryngology; Kyosai Tachikawa Hospital; Tachikawa Tokyo Japan
| | - Kuninori Otsuka
- Department of Otorhinolaryngology; Saiseikai Yokohamashi Tobu Hospital; Yokohama Kanagawa Japan
| | - Yoshihiro Watanabe
- Department of Otorhinolaryngology; Tokyo Saiseikai Central Hospital; Minato Tokyo Japan
| | - Mariko Sekimizu
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery; Keio University School of Medicine; Shinjuku Tokyo Japan
| |
Collapse
|
26
|
Spontaneous Regression of a Hypoglossal Neurinoma: Case Report and Review of the Literature. World Neurosurg 2017; 105:1033.e7-1033.e9. [DOI: 10.1016/j.wneu.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/20/2022]
|
27
|
Nesvick CL, Perry A, Graffeo CS, Raghunathan A, Hammack JE, Van Gompel JJ. Trochlear Schwannoma Presenting with Isolated Trigeminal Neuralgia. World Neurosurg 2017; 103:951.e13-951.e20. [DOI: 10.1016/j.wneu.2017.04.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
|
28
|
Park HH, Hong CK, Jung HH, Chang WS, Kim CH, Lee WS, Lee SC, Park YG, Chang JH. The Role of Radiosurgery in the Management of Benign Head and Neck Tumors. World Neurosurg 2016; 87:116-23. [DOI: 10.1016/j.wneu.2015.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
|
29
|
Prasad GL, Sharma MS, Kale SS, Agrawal D, Singh M, Sharma BS. Gamma Knife radiosurgery in the treatment of abducens nerve schwannomas: a retrospective study. J Neurosurg 2016; 125:832-837. [PMID: 26824380 DOI: 10.3171/2015.8.jns151140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Of the intracranial schwannomas, those arising from the vestibular nerves are the most common. Abducens nerve (AN) schwannomas are very rare, and there is limited literature on their optimal management. Therapeutic options include surgery and/or stereotactic radiosurgery. The aim of this study was to evaluate the role of Gamma Knife radiosurgery (GKRS) in these sixth cranial nerve (CN) schwannomas. METHODS The authors performed a retrospective analysis of patients who had undergone GKRS for intracranial tumors at their institute in the period from 2003 to 2010. Inclusion criteria were as follows: isolated AN paresis on presentation, a lesion along the course of the sixth CN, and imaging features characteristic of a schwannoma. Patients with other CN deficits and neurofibromatosis Type 2 were excluded. Symptomatic improvement was defined as the resolution of or an improvement in diplopia noted on a subjective basis or as an improvement in lateral eyeball excursion noted objectively on follow-up. A reduction in tumor volume by at least 20%, as noted by comparing the pre- and post-GKRS images, was deemed significant. RESULTS Six patients with a mean age of 37.1 years (range 17-55 years) underwent primary GKRS. There were 2 prepontine cistern, 3 cavernous sinus, and 1 cisterno-cavernous tumor. The mean duration of symptoms was 6.1 months (range 3-12 months). The mean tumor volume was 3.3 cm3 (range 1.5-4.8 cm3). The mean tumor margin radiation dose was 12.5 Gy (range 12-14 Gy), while the median margin dose was 12 Gy (50% isodose line). The median number of isocenters used was 5 (range 4-8). The brainstem received an average 8.35-Gy radiation dosage (range 5.5-11 Gy). The mean follow-up duration was 44.3 months (range 24-78 months). Symptoms remained stable in 1 patient, improved in 3, and resolved in 2 (total improvement 83%). Magnetic resonance imaging at the last follow-up showed a stable tumor size in 3 patients (50%) and a reduction in the other 3. Thus, the tumor control rate achieved was 100%. No new CN deficits were noted. CONCLUSIONS Abducens nerve schwannomas are rare intracranial tumors. They can be cavernous, cisternal, or cisterno-cavernous in location. Excellent tumor control rates and symptomatic improvement can be achieved with GKRS, which appears to be a safe and effective, minimally invasive modality for the treatment of such lesions. Therefore, it is reasonable to consider GKRS as the initial treatment of choice for this rare pathology. Long-term follow-up will be essential for further recommendations.
Collapse
Affiliation(s)
| | - Manish Singh Sharma
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Bhawani Shankar Sharma
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
30
|
Hasegawa T, Kato T, Kida Y, Sasaki A, Iwai Y, Kondoh T, Tsugawa T, Sato M, Sato M, Nagano O, Nakaya K, Nakazaki K, Kano T, Hasui K, Nagatomo Y, Yasuda S, Moriki A, Serizawa T, Osano S, Inoue A. Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan. J Neurosurg 2016; 125:822-831. [PMID: 26799304 DOI: 10.3171/2015.8.jns151156] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm3, and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3-fraction schedule. RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively. CONCLUSIONS GKS resulted in good tumor control in patients with either primary or residual JFSs. Although some patients experienced some degree of symptomatic deterioration after treatment, persistent adverse radiation effects were seen in only 3% of the entire series at the last follow-up. Lower cranial nerve deficits were extremely rare adverse radiation effects, and preexisting hoarseness and swallowing disturbances improved in two-thirds of patients. These results indicated that GKS was a safe and reasonable alternative to surgical resection in selected patients with JFSs.
Collapse
Affiliation(s)
| | - Takenori Kato
- Department of Neurosurgery, Komaki City Hospital, Komaki
| | - Yoshihisa Kida
- Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya
| | - Ayaka Sasaki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Osaka
| | | | | | - Manabu Sato
- Department of Neurosurgery, Rakusai Shimizu Hospital, Kyoto
| | - Mitsuya Sato
- Department of Neurosurgery, Kitanihon Neurosurgical Hospital, Gosen
| | - Osamu Nagano
- Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara
| | - Kotaro Nakaya
- Department of Neurosurgery, Atami Tokoro Memorial Hospital, Atami
| | - Kiyoshi Nakazaki
- Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama
| | - Tadashige Kano
- Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki
| | - Koichi Hasui
- Department of Neurosurgery, Okamura Isshindow Hospital, Okayama
| | | | | | | | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo
| | - Seiki Osano
- Department of Neurosurgery, Shonan Fujisawa Tokushukai Hospital, Fujisawa; and
| | - Akira Inoue
- Department of Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| |
Collapse
|
31
|
Kee HJ, Yoo YJ, Kim JH, Yang HK. A Case of Trochlear Nerve Schwannoma Presenting with Binocular Diplopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.11.1812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Ju Kee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yung Ju Yoo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
32
|
Inoue T, Shima A, Hirai H, Suzuki F, Matsuda M. Trochlear Nerve Schwannoma Treated with Gamma Knife after Excision: A Case Report and Review of the Literature. J Neurol Surg Rep 2015; 76:e248-52. [PMID: 26623236 PMCID: PMC4648728 DOI: 10.1055/s-0035-1564059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/17/2015] [Indexed: 11/23/2022] Open
Abstract
Trochlear nerve schwannomas are extremely rare. We present a surgically excised case of trochlear nerve schwannoma followed by Gamma Knife (ELEKTA, Stockholm, Sweden) after histologic confirmation. A 52-year-old man presented with diplopia, gait disturbance, and sensory disturbance. Magnetic resonance imaging demonstrated a large cystic mass at ambient cistern on the right side. Subtotal excision followed by Gamma Knife surgery was undertaken. His neurologic symptoms disappeared with radiologic reduction in size at 15-month follow-up. Because Gamma Knife can manage trochlear nerve schwannomas well, surgical excision should be reserved for large ones and limited to subcapsular or subtotal removal with the expectation of possible recovery of neurologic dysfunction.
Collapse
Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Ayako Shima
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Hisao Hirai
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Fumio Suzuki
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Masayuki Matsuda
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| |
Collapse
|
33
|
Park CK, Lee SH, Choi MK, Choi SK, Park BJ, Lim YJ. Communicating Hydrocephalus Associated with Intracranial Schwannoma Treated by Gamma Knife Radiosurgery. World Neurosurg 2015; 89:593-600. [PMID: 26585729 DOI: 10.1016/j.wneu.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Gamma knife radiosurgery (GKRS) has been established as an effective and safe treatment for intracranial schwannoma. However, serious complications can occur after GKRS, including hydrocephalus. The pathophysiology and risk factors of this disorder are not yet fully understood. The objective of the study was to assess potential risk factors for hydrocephalus after GKRS. METHODS We retrospectively reviewed the medical radiosurgical records of 244 patients who underwent GKRS to treat intracranial schwannoma. The following parameters were analyzed as potential risk factors for hydrocephalus after GKRS: age, sex, target volume, irradiation dose, prior tumor resection, treatment technique, and tumor enhancement pattern. The tumor enhancement pattern was divided into 2 groups: group A (homogeneous enhancement) and group B (heterogeneous or rim enhancement). RESULTS Of the 244 patients, 14 of them (5.7%) developed communicating hydrocephalus. Communicating hydrocephalus occurred within 2 years after GKRS in most patients (92.8%). No significant association was observed between any of the parameters investigated and the development of hydrocephalus, with the exception of tumor enhancement pattern. Group B exhibited a statistically significant difference by univariate analysis (P = 0.002); this difference was also significant by multivariate analysis (P = 0.006). CONCLUSION Because hydrocephalus is curable, patients should be closely monitored for the development of this disorder after GKRS. In particular, patients with intracranial schwannomas with irregular enhancement patterns or cysts should be meticulously observed.
Collapse
Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Man Kyu Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong Jin Park
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Jin Lim
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
| |
Collapse
|
34
|
Li X, Li J, Li J, Wu Z. Schwannoma of the 6th nerve: case report and review of the literature. Chin Neurosurg J 2015. [DOI: 10.1186/s41016-015-0004-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
35
|
Aboukais R, Bonne NX, Baroncini M, Zairi F, Schapira S, Vincent C, Lejeune JP. Management of multiple tumors in neurofibromatosis type 2 patients. Neurochirurgie 2015; 64:364-369. [PMID: 26071178 DOI: 10.1016/j.neuchi.2014.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/15/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neurofibromatosis type 2 is characterized by the presence of bilateral vestibular schwannomas. However, other nervous system tumors may also occur. Therefore, the management of NF2 patients is complex and requires a multidisciplinary discussion in a specialized center. MATERIALS AND METHODS All recent articles concerning tumors other than vestibular schwannoma in NF2 disease were reviewed, using PubMed databases. RESULTS Intracranial meningiomas occur in 50% of NF2 patients, and are often multiple. Surgery remains the main treatment and should be performed in cases of growing tumors. The role of antiangiogenic therapy is currently under evaluation and the role of radiosurgery still remains to be defined in NF2 disease. Spinal tumors occur in about half of NF2 patients. Surgery should be discussed when radiological tumor progression is demonstrated, even if spinal tumors are asymptomatic, in order to preserve neurological function and good quality of life. As regards lower cranial nerve schwannomas, radiosurgery appears to be a more appropriate treatment for growing tumor with a small volume in order to avoid post-operative complications, especially swallowing disorders. Facial nerve schwannomas may appear, on MRI, like vestibular schwannomas. The diagnosis should be suspected when the facial palsy is an early symptom during cerebello-pontine tumor progression. Trigeminal schwannomas are frequent in NF2 disease and fortunately they are often asymptomatic. Among major neurofibromatosis types, peripheral nerve sheath schwannomas are only present in patients with NF2 disease and schwannomatosis. Surgical resection is required when the cutaneous schwannomas is painful or when tumor progression is observed and causes symptoms. CONCLUSION Tumors other than vestibular schwannoma are also associated with a poor prognosis in NF2 patients. Surgery remains the main treatment in most cases. Each treatment decision in NF2 disease requires a complete evaluation of all cranial and spinal locations of the disease in order to establish surgical priorities and strategies.
Collapse
Affiliation(s)
- R Aboukais
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France.
| | - N-X Bonne
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - M Baroncini
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - F Zairi
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - S Schapira
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - C Vincent
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - J-P Lejeune
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| |
Collapse
|
36
|
Mohyeldin A, Prevedello DM, Jamshidi AO, Ditzel Filho LFS, Carrau RL. Nuances in the treatment of malignant tumors of the clival and petroclival region. Int Arch Otorhinolaryngol 2015; 18:S157-72. [PMID: 25992140 PMCID: PMC4399585 DOI: 10.1055/s-0034-1395267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnostic identification, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to the skull base. Data Synthesis A literature review was conducted, searching for basic science and clinical evidence from PubMed, Medline, and the Cochrane Database. The selection criteria encompassed original articles including data from both basic science and clinical literature, case series, case reports, and review articles on the etiology, diagnosis, treatment, and management of skull base malignancies in the clival and petroclival region. Conclusions The management of petroclival malignancies requires a multidisciplinary team to deliver the most complete surgical resection, with minimal morbidity, followed by appropriate adjuvant therapy. We advocate the combination of endoscopic and open approaches (traditional or minimally invasive) as required by the particular tumor followed by radiation therapy to optimize oncologic outcomes.
Collapse
Affiliation(s)
- Ahmed Mohyeldin
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States ; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Ali O Jamshidi
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Leo F S Ditzel Filho
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Ricardo L Carrau
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States ; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| |
Collapse
|
37
|
Moon JH, Chang WS, Jung HH, Lee KS, Park YG, Chang JH. Gamma Knife surgery for facial nerve schwannomas. J Neurosurg 2015; 121 Suppl:116-22. [PMID: 25434945 DOI: 10.3171/2014.8.gks141504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT The aim of this study was to evaluate the tumor control rate and functional outcomes after Gamma Knife surgery (GKS) among patients with a facial nerve schwannoma. METHODS The authors reviewed the radiological data and clinical records for 14 patients who had consecutively undergone GKS for a facial nerve schwannoma. Before GKS, 12 patients had facial palsy, 7 patients had hearing disturbance, and 5 patients had undergone partial or subtotal tumor resection. The mean and median tumor volumes were 3707 mm(3) and 3000 mm(3), respectively (range 117-10,100 mm(3)). The mean tumor margin dose was 13.2 Gy (range 12-15 Gy), and the mean maximum tumor dose was 26.4 Gy (range 24-30 Gy). The mean follow-up period was 80.7 months (range 2-170 months). RESULTS Control of tumor growth was achieved in all 12 (100%) patients who were followed up for longer than 2 years. After GKS, facial nerve function improved in 2 patients, remained unchanged in 9 patients, and worsened in 3 patients. All patients who had had serviceable hearing at the preliminary examination maintained their hearing at a useful level after GKS. Other than mild tinnitus reported by 3 patients, no other major complications developed. CONCLUSIONS GKS for facial nerve schwannomas resulted in excellent tumor control rates and functional outcomes. GKS might be a good primary treatment option for patients with a small- to medium-sized facial nerve schwannoma when facial nerve function and hearing are relatively preserved.
Collapse
|
38
|
Aboukais R, Zairi F, Bonne NX, Baroncini M, Schapira S, Vincent C, Lejeune JP. Causes of mortality in neurofibromatosis type 2. Br J Neurosurg 2014; 29:37-40. [DOI: 10.3109/02688697.2014.952266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Yang T, Juric-Sekhar G, Born D, Sekhar LN. A case of malignant peripheral nerve sheath tumor of the hypoglossal nerve after stereotactic radiosurgery treatment. J Neurol Surg Rep 2014; 75:e42-6. [PMID: 25083387 PMCID: PMC4110120 DOI: 10.1055/s-0033-1358797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/08/2013] [Indexed: 10/28/2022] Open
Abstract
Objectives Hypoglossal schwannomas are rare. Surgical resection has been the standard treatment modality. Radiosurgery has been increasingly used for treatment. Radiation-associated secondary malignancy/malignant transformation has not been documented in the literature for the treatment of nonvestibular schwannomas. Setting The patient was a 52-year-old man with an enlarging high cervical/skull base lesion 8.5 years after CyberKnife treatment of a presumed vagal schwannoma. A decision was made for surgical resection, and the tumor was found to originate from the hypoglossal nerve intraoperatively. Final pathology diagnosis was malignant peripheral nerve sheath tumor. Results Patient had a gross total resection. Three months after resection, he received fractionated radiation of 50 Gy in 25 fractions and a boost gamma knife radiosurgery of 10 Gy to the 50% isodose surface. He remained tumor free on repeat magnetic resonance imaging 9 months after the resection. Conclusion Although extremely rare, radiation treatment of nonvestibular schwannomas can potentially cause malignant transformation.
Collapse
Affiliation(s)
- Tong Yang
- Department of Neurosurgery, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Gordana Juric-Sekhar
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Donald Born
- Department of Pathology, University of Washington, School of Medicine, Seattle, Washington, United States
| | - Laligam N Sekhar
- Department of Neurosurgery, University of Washington, School of Medicine, Seattle, Washington, United States
| |
Collapse
|
40
|
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.
Collapse
Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan.
| | | | | | | |
Collapse
|
41
|
Suri A, Bansal S, Singh M, Mahapatra AK, Sharma BS. Jugular foramen schwannomas: A single institution patient series. J Clin Neurosci 2014; 21:73-7. [DOI: 10.1016/j.jocn.2013.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
|
42
|
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.
Collapse
Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture 485-8520, Japan.
| |
Collapse
|
43
|
Intra-parotid facial nerve schwannoma with intra-temporal extension; a case report. Is there a role for stereotactic radiotherapy? Am J Otolaryngol 2013; 34:258-61. [PMID: 23318048 DOI: 10.1016/j.amjoto.2012.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 11/23/2022]
Abstract
Facial nerve schwannoma (FNS) is an extremely rare benign tumour that may arise anywhere along the course of the facial nerve; the standard treatment is total removal via microsurgery. Stereotactic radiotherapy has been shown to be effective in the treatment of skull base tumours, in particular for acoustic neuromas; it is interesting to notice that also the few data existing in literature about the use of radiotherapy for non acoustic schwannomas show an excellent local control rate and few adverse effects. Here we report a case of facial nerve neuroma, involving the nerve sheath from the geniculate ganglion to the parotid gland, treated with fractionated stereotactic radiotherapy after debulking surgery.
Collapse
|
44
|
Sun J, Zhang J, Yu X, Qi S, Du Y, Ni W, Hu Y, Tian Z. Stereotactic radiosurgery for trigeminal schwannoma: a clinical retrospective study in 52 cases. Stereotact Funct Neurosurg 2013; 91:236-42. [PMID: 23548989 DOI: 10.1159/000345258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 10/13/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the radiological and clinical outcomes in a series of patients in whom stereotactic radiosurgery (SRS) was used to treat trigeminal schwannomas. METHODS The records of 52 patients who underwent SRS for trigeminal schwannoma were reviewed using a retrospective study. The median patient age was 47.1 years (range, 18-77); 20 patients (38.5%) had undergone prior tumor resection and 32 (61.5%) underwent radiosurgery on the basis of imaging diagnosis only. The most frequent presenting symptoms were facial numbness (29 patients), jaw weakness (11 patients), facial pain (10 patients) and diplopia (4 patients). Fifty-two cases with solid tumors were mainly solid in 44 cases (84.6%), mostly cystic in 2 cases (3.8%), and cystic and solid mixed in 6 cases (11.5%). Two cases of mostly cystic tumor first underwent stereotactic cystic fluid aspiration and intracavitary irradiation, and then had MRI localization scan again for gamma knife treatment. The mean tumor volume was 7.2 ml (range, 0.5-38.2). The mean prescription radiation dose was 13.9 Gy (range, 11-17), and the mean prescription isodose configuration was 47.9%. RESULTS At a mean follow-up of 61 months (range, 12-156), neurological symptoms or signs improved in 35 patients (67.3%), 14 patients (26.9%) had a stable lesion, and worsening of the disease occurred in 2 patients (3.8%). On imaging, the schwannomas almost disappeared in 8 (15.4%), shrank in 32 (61.5%), remained stable in 5 (9.6%), and increased in size in 7 patients (13.5%). Tumor growth control was achieved in 45 (86.5%) of the 52 patients. CONCLUSIONS SRS is an effective and minimally invasive management option for patients with residual or newly diagnosed trigeminal schwannomas. The use of SRS to treat trigeminal schwannomas resulted in good tumor control and functional improvement.
Collapse
Affiliation(s)
- Junzhao Sun
- Department of Neurosurgery, Navy General Hospital of PLA, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Yen CP, Schlesinger D, Sheehan JP. Gamma Knife® radiosurgery for trigeminal neuralgia. Expert Rev Med Devices 2012; 8:709-21. [PMID: 22029468 DOI: 10.1586/erd.11.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Trigeminal neuralgia is characterized by a temporary paroxysmal lancinating facial pain in the trigeminal nerve distribution. The prevalence is four to five per 100,000. Local pressure on nerve fibers from vascular loops results in painful afferent discharge from an injured segment of the fifth cranial nerve. Microvascular decompression addresses the underlying pathophysiology of the disease, making this treatment the gold standard for medically refractory trigeminal neuralgia. In patients who cannot tolerate a surgical procedure, those in whom a vascular etiology cannot be identified, or those unwilling to undergo an open surgery, stereotactic radiosurgery is an appropriate alternative. The majority of patients with typical facial pain will achieve relief following radiosurgical treatment. Long-term follow-up for recurrence as well as for radiation-induced complications is required in all patients undergoing stereotactic radiosurgery for trigeminal neuralgia.
Collapse
Affiliation(s)
- Chun-Po Yen
- Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | | | | |
Collapse
|
46
|
Peker S, Sengöz M, Kılıç T, Pamir MN. Gamma knife radiosurgery for jugular foramen schwannomas. Neurosurg Rev 2012; 35:549-53; discussion 553. [PMID: 22395434 DOI: 10.1007/s10143-012-0380-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/06/2011] [Accepted: 01/27/2012] [Indexed: 12/01/2022]
Abstract
Jugular foramen schwannomas are very rare tumors. Advances in skull base surgery have led to more aggressive resection of these tumors, but surgery may associate with development of new neurological deficits. In this report, we analyze the long-term results for 17 patients with newly diagnosed or residual/recurrent jugular foramen schwannoma who underwent gamma-knife treatment. During a mean 64 months of follow-up, magnetic resonance imaging revealed reduced tumor size in 13 cases and no size change in four cases. The tumor growth control rate was 100% and only one patient had transient hoarseness. For patients who have small- to moderate-sized jugular foramen schwannomas, gamma-knife radiosurgery is associated with good tumor control and carries minimal risk of adverse radiation effects.
Collapse
Affiliation(s)
- Selçuk Peker
- Department of Neurosurgery, Acıbadem University School of Medicine, Istanbul, Turkey.
| | | | | | | |
Collapse
|
47
|
Stereotactic radiosurgery for trigeminal schwannomas. Acta Neurochir (Wien) 2012; 154:277-83. [PMID: 21918834 DOI: 10.1007/s00701-011-1146-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Traditionally trigeminal schwannomas (TS) have been treated microsurgically; however, this is often associated with significant morbidity, and complete excision remains a challenge. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative in treating TS. We report on our cumulative experience of using SRS in the treatment of TS. MATERIALS AND METHODS Seventy-four TS patients (four with NF2) were treated with SRS using the Leksell Gamma Knife. Mean age (±1 SD) at treatment was 47.1 (15.5) years with a mean interval between presentation and treatment of 30.9 months. Thirty (40.5%) patients had undergone previous surgery on average 47.3 months prior to SRS. The average target volume was 5.3 cm(3) (range 0.4-19.9 cm(3)) and was treated with a mean prescription dose of 16.4 (3.9) Gy to the tumour margin. RESULTS Average follow-up was 48.2 months (range 6-168 months). Tumour size remained static in 58 (78.4%) patients and showed radiological evidence of shrinkage in 11 (14.9%). Tumour progression occurred in five (6.6%) patients on average 40 months after SRS (range 12-108). Progression-free survival (PFS) for all patients was 98.5% at 1 year, 92.7% at 5 years and 79.4% at 10 years. Log-rank analysis indicated a significantly worse outcome for NF2 patients (p = 0.001) who demonstrated a PFS of 100% at 1 year and 50% at 5 years. Seven patients developed adverse radiation effects whilst improvements in pre-treatment cranial nerve dysfunction were achieved in eight patients. CONCLUSIONS SRS is an effective treatment option in patients with residual or newly diagnosed TS. In view of the results of this study we would advocate a more front-line role for the Gamma Knife in the treatment of this tumour group.
Collapse
|
48
|
Enseñat J, Alobid I, de Notaris M, Sanchez M, Valero R, Prats-Galino A, Ferrer E. Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report. Neurosurgery 2011; 69:onsE121-7; discussion onsE127-8. [PMID: 21572362 DOI: 10.1227/neu.0b013e318223b637] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Aneurysms arising from the vertebral and posterior inferior cerebellar artery complex account for only 0.5 to 3% of all aneurysms. Surgery for these aneurysms is technically challenging because of the deep location and intimate relation with the medulla and lower cranial nerves. The authors report the case of a patient with a right vertebral-posterior inferior cerebellar artery complex (VA-PICA) aneurysm that was successfully clipped via an extended endoscopic endonasal transclival approach. CLINICAL PRESENTATION A 74-year-old woman with the sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. A computed tomography (CT) of the brain revealed diffuse subarachnoid hemorrhage associated with intraventricular hemorrhage and incipient hydrocephalus. Cerebral angiography revealed a 1.2-mm aneurysm arising at the origin of the right PICA. The aneurysm was considered unsuitable for selective coil embolization, so neck clipping was performed. With the use of an extended endoscopic endonasal transclival approach, the aneurysm was accurately reached endoscopically and successfully clipped from the parent artery. The patient was discharged neurologically intact. CONCLUSION To the best of the authors' knowledge, this is the first report of a successfully treated VA-PICA ruptured aneurysm using a pure endoscopic endonasal transclival approach. Endoscopic surgery may be added to the armamentarium of procedures for the treatment of posterior circulation aneurysms.
Collapse
Affiliation(s)
- Joaquim Enseñat
- Departments of Neurosurgery, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
49
|
Elsharkawy M, Xu Z, Schlesinger D, Sheehan JP. Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes. J Neurosurg 2011; 116:66-72. [PMID: 21962159 DOI: 10.3171/2011.8.jns11215] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Most intracranial schwannomas arise from cranial nerve (CN) VIII. Stereotactic radiosurgery is a mainstay of treatment for vestibular schwannomas. Intracranial schwannomas arising from other CNs are much less common. We evaluate the efficacy of Gamma Knife surgery on nonvestibular schwannomas including trigeminal, hypoglossal, abducent, facial, trochlear, oculomotor, glossopharyngeal, and jugular foramen tumors. METHODS Thirty-six patients with nonvestibular schwannomas were treated at the University of Virginia Gamma Knife center from 1989 to 2008. The median patient age was 48 years (mean 45.6 years, range 10-72 years). Schwannomas arose from the following CNs: CN III (in 1 patient), CN IV (in 1), CN V (in 25), CN VI (in 2), CN VII (in 1), CN IX (in 1), and CN XII (in 3). In 2 patients, tumors arose from the jugular foramen. The median tumor volume was 2.9 cm(3) (mean 3.3 cm(3), range 0.07-8.8 cm(3)). The median margin dose was 13.5 Gy (range 9.3-20 Gy); the median maximum dose was 30 Gy (range 21.7-50.0 Gy). RESULTS The mean and median follow-up times of 36 patients were 54 and 37 months, respectively (range 2-180 months). At the last radiological follow-up, the tumor size had decreased in 20 patients, remained stable in 9 patients, and increased in 7 patients. The 2-year actuarial progression-free survival was 91%. Higher maximum dose was statistically related to tumor control (p = 0.027). Thirty-three patients had adequate clinical follow-up. Among them, 21 patients had improvement in their presenting symptoms, 8 patients were stable after treatment with no worsening of their presenting symptoms, 2 patients developed new symptoms, and 1 patient experienced symptom deterioration. Notably, 1 patient with neurofibromatosis Type 2 developed new symptoms that were unrelated to the tumor treated with Gamma Knife surgery. CONCLUSIONS Gamma Knife surgery is a reasonably effective treatment option for patients with nonvestibular schwannomas. Patients require careful follow-up for tumor progression and signs of neurological deterioration.
Collapse
Affiliation(s)
- Mohamed Elsharkawy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | |
Collapse
|
50
|
Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal Schwannomas: Skull Base Approaches and Operative Results in 105 Patients. Oper Neurosurg (Hagerstown) 2011; 70:132-43; discussion 143-4. [DOI: 10.1227/neu.0b013e31822efb21] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Trigeminal schwannomas make up 0.8% to 8% of all intracranial schwannomas.
OBJECTIVE:
To analyze our surgical experience with trigeminal schwannomas.
METHODS:
We performed 107 operations on 105 patients harboring trigeminal schwannomas over the past 30 years. We classified the tumors as peripheral, ganglion cavernous, posterior fossa root, and dumbbell types according to the portion of the nerve that gave rise to the tumor.
RESULTS:
Fourteen were peripheral-type tumors (13.1%), 39 (36.4%) were ganglion cavernous type, 22 (20.6%) were posterior fossa root type, and 32 (30.0%) were dumbbell type. Sixty-five tumors were solid, 35 were mixed, and only 7 were cystic. Among solid tumors, 14 were vascular, fibrous, and adherent to adjacent structures. Total or near-total removal was performed in 86 cases (81.9%), and subtotal removal was achieved in 18 (17.1%). The most common symptom was facial hypesthesia, occurring in 69 patients. This symptom improved in 11 patients, persisted in 50 patients, and worsened in 8 patients after surgery. New postoperative hypesthesia was observed in 8 patients. The second most common symptom was facial pain, observed in 24 patients. Facial pain subsided in 22 and persisted in 2 patients after surgery. Diplopia was observed in 21 patients. This symptom improved postoperatively in 14 patients, persisted in 6 patients, and worsened in 1 patient.
CONCLUSION:
The present series demonstrates acceptable results using microsurgical treatment to remove trigeminal schwannomas. Pain and diplopia may be relieved after surgery; however, hypesthesia frequently remains or may be worsened by surgery.
Collapse
Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Takanori Fukushima
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Ali R. Zomordi
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Yoichi Nonaka
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Allan H. Friedman
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|