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Sri Krishna GS, Pahwa B, Jagdevan A, Singh M, Kale S, Agrawal D. Tumor Control and Hearing Preservation After Gamma Knife Radiosurgery for Vestibular Schwannomas in Neurofibromatosis Type 2-A Retrospective Analysis of 133 Tumors. World Neurosurg 2023; 171:e820-e827. [PMID: 36587894 DOI: 10.1016/j.wneu.2022.12.118] [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: 11/04/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study was conducted with the aim to estimate long-term tumor control and hearing preservation rates in patients with neurofibromatosis 2 (NF2)-related vestibular schwannoma (VS), document retreatment success rate, and assess the associated predictive factors. METHODS This was a retrospective analysis of patients with NF2-associated VS who underwent Gamma Knife radiosurgery (GKRS) between 2009 and 2020 and had a minimum follow-up of 1 year. Loss of tumor control was defined as greater than 10% increase in volume in more than one follow-up imaging or the need for retreatment in the form of repeat GKRS or surgery. The Kaplan-Meier method was used to evaluate actuarial tumor control and hearing preservation rates. RESULTS In total, 85 patients with 133 VSs were included in the study. The mean age was 29.8 years. In total, 57 tumors showed tumor regression, 35 showed stable disease, and 23 progressed in size at last follow up. Actuarial tumor control rates after 1, 3, 5, and 9 years were 95%, 79%, 75%, and 55%, respectively, with overall tumor control rate being 85%. Hearing worsened in 39 patients, and facial nerve dysfunction occurred in 4 patients. Five tumors underwent retreatment with GKRS at a median duration of 27.6 months (19-36 months) following the first GKRS. CONCLUSIONS This is the largest radiosurgical series of NF2-associated VS reported to date. GKRS provides a high rate of long-term local tumor control with a low risk of neurologic deprivation for patients with these tumors. The need for retreatment with GKRS, although low, is associated with good tumor control and lesser complications.
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Affiliation(s)
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Aman Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Labuschagne JJ, Chetty D. Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report. Neurosurg Focus 2020; 46:E11. [PMID: 31153146 DOI: 10.3171/2019.3.focus1948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/18/2019] [Indexed: 11/06/2022]
Abstract
The documentation and exact incidence of stereotactic radiosurgery (SRS)-induced neoplasia is not well understood, with most literature restricted to single case reports and single-center retrospective reviews. The authors present a rare case of radiosurgery-induced glioblastoma multiforme (GBM) following radiosurgical treatment of a meningioma. A 74-year-old patient with a sporadic meningioma underwent radiosurgery following surgical removal of a WHO grade II meningioma. Eighteen months later she presented with seizures, and MRI revealed an intraaxial tumor, which was resected and proven to be a glioblastoma. As far as the authors are aware, this case represents the third case of GBM following SRS for a meningioma. This report serves to increase the awareness of this possible complication following SRS. The possibility of this rare complication should be explained to patients when obtaining their consent for radiosurgery.
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Affiliation(s)
- Jason J Labuschagne
- 1Department of Neurosurgery, University of the Witwatersrand.,2Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital; and.,3Gamma Knife Centre, Milpark, Johannesburg, South Africa
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Yao L, Alahmari M, Temel Y, Hovinga K. Therapy of Sporadic and NF2-Related Vestibular Schwannoma. Cancers (Basel) 2020; 12:E835. [PMID: 32244314 PMCID: PMC7226024 DOI: 10.3390/cancers12040835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
Vestibular schwannoma (VS) is a benign primary brain tumor that occurs sporadic or as part of a genetic syndrome. The most common cause is the mutation of the NF2 tumor suppressor gene that is involved in the production of the protein merlin. Merlin plays a role in cell growth and cell adhesion. In patients with NF2, the VSs arise bilaterally and coincide with other brain tumors. In sporadic VS, the tumor is typically unilateral and does not coincide in combination with other tumors. MRI is the standard imaging technique and can be used to assess the size and aspect of the tumor as well as the progression of disease. The preferred management of large VS in both VS types is surgery with or without adjuvant radiation. The management for the medium- or small-sized VS includes wait and scan, radiotherapy and/or surgery. This choice depends on the preference of the patient and institutional protocols. The outcomes of surgical and radiotherapy treatments are improving due to progress in surgical equipment/approaches, advances in radiation delivery techniques and dose optimizations protocols. The main purpose of the management of VS is preserving function as long as possible in combination with tumor control.
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Affiliation(s)
- Longping Yao
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; (L.Y.); (M.A.); (Y.T.)
| | - Mohammed Alahmari
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; (L.Y.); (M.A.); (Y.T.)
- Department of Radiology, King Fahad Hospital of Imam Abdulrahman Bin Faisal University, P.O. Box 40046, 31952 AL-Khobar, Saudi Arabia
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; (L.Y.); (M.A.); (Y.T.)
| | - Koos Hovinga
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; (L.Y.); (M.A.); (Y.T.)
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Narayan DS, Traber GL, Figueira E, Pirbhai A, Landau K, Davis G, Crompton J, Selva D. Natural history of primary paediatric optic nerve sheath meningioma: case series and review. Br J Ophthalmol 2017; 102:1147-1153. [PMID: 29146762 DOI: 10.1136/bjophthalmol-2017-310672] [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: 05/21/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To study the natural history, clinical and radiological characteristics of primary paediatric optic nerve sheath meningioma (PPONSM). METHODS Retrospective study of eight paediatric patients who were treated between 1994 and 2016 at the University Hospital Zurich, Switzerland and the Royal Adelaide Hospital, Australia. Clinical records and imaging studies were reviewed. RESULTS The mean age at presentation was 11 years (range: 6-17 years). There were six female patients and two male patients. 2/8 patients had associated neurofibromatosis type 2. Patients were followed up for 71-297 months (mean 156±70 months). 6/8 patients were observed through the course of their disease and 2/8 patients were treated with radiotherapy. 2/8 patients who were observed had minimal change in vision and did not experience tumour growth after long-term follow-up. CONCLUSIONS This is the largest PPONSM case series with long-term data on patients treated conservatively. We highlight that a small subset of these tumours are indolent and can be managed using observation alone.
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Affiliation(s)
- Daniel S Narayan
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Ghislaine L Traber
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edwin Figueira
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Adnan Pirbhai
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Klara Landau
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Garry Davis
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - John Crompton
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Department of Ophthalmology, South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Se YB, Kim DG, Park SH, Chung HT. Radiation-induced osteosarcoma after Gamma Knife surgery for vestibular schwannoma: a case report and literature review. Acta Neurochir (Wien) 2017; 159:385-391. [PMID: 27866298 DOI: 10.1007/s00701-016-3031-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
We present a rare case of radiation-induced osteosarcoma following Gamma Knife® surgery (GKS) for a vestibular schwannoma (VS). A 49-year-old female with sporadic VS underwent GKS. Serial follow-up imaging showed that the tumor size decreased. Six years after GKS, magnetic resonance imaging demonstrated regrowth of the tumor. The tumor was removed via the retrosigmoid approach. Interestingly, the final pathology report confirmed osteosarcoma arising in schwannoma with direct transition (osteosarcoma component: 90 %, schwannoma component: 10 %). The osteosarcoma was considered to be a radiation-induced malignancy. The possibility of this rare complication should be explained to the patient before GKS, and the patient should be screened periodically after GKS.
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Kruyt IJ, Verheul JB, Hanssens PEJ, Kunst HPM. Gamma Knife radiosurgery for treatment of growing vestibular schwannomas in patients with neurofibromatosis Type 2: a matched cohort study with sporadic vestibular schwannomas. J Neurosurg 2017; 128:49-59. [PMID: 28128697 DOI: 10.3171/2016.9.jns161463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Neurofibromatosis Type 2 (NF2) is a tumor syndrome characterized by an autosomal dominant pattern of inheritance. The hallmark of NF2 is the development of bilateral vestibular schwannomas (VSs), generally by 30 years of age. One of the first-line treatment options for small to medium-large VSs is radiosurgery. Although radiosurgery shows excellent results in sporadic VS, its use in NF2-related VS is still a topic of dispute. The aim of this study was to evaluate long-term tumor control, hearing preservation rates, and factors influencing outcome of optimally dosed, contemporary Gamma Knife radiosurgery (GKRS) for growing VSs in patients with NF2 and compare the findings to data obtained in patients with sporadic VS also treated by means of GKRS. METHODS The authors performed a retrospective analysis of 47 growing VSs in 34 NF2 patients who underwent GKRS treatment performed with either the Model C or Perfexion Leksell Gamma Knife, with a median margin dose of 11 Gy. Actuarial tumor control rates were estimated using the Kaplan-Meier method. For patient- and treatment-related factors, a Cox proportional hazards model was used to identify predictors of outcome. Trigeminal, facial, and vestibulocochlear nerve function were assessed before and after treatment. NF2-related VS patients were matched 1:1 with sporadic VS patients who were treated in the same institute, and the same indications for treatment, definitions, and dosimetry were used in order to compare outcomes. RESULTS Actuarial tumor control rates in NF2 patients after 1, 3, 5, and 8 years were 98%, 89%, 87%, and 87%, respectively. Phenotype and tumor volume had significant hazard rates of 0.086 and 22.99, respectively, showing that Feiling-Gardner phenotype and a tumor volume not exceeding 6 cm3 both were associated with significantly better outcome. Actuarial rates of serviceable hearing preservation after 1, 3, 5, and 7 years were 95%, 82%, 59%, and 33%, respectively. None of the patients experienced worsening of trigeminal nerve function. Facial nerve function worsened in 1 patient (2.5%). No significant differences in tumor control, hearing preservation, or complications were found in comparing the results of GKRS for NF2-related VS versus GKRS for sporadic VS. CONCLUSIONS With modern GKRS, the use of low margin doses for treating growing VSs in patients with NF2 demonstrates good long-term tumor control rates. Feiling-Gardner phenotype and tumor volume smaller than 6 cm3 seem to be independently associated with prolonged progression-free survival, highlighting the clinical importance of phenotype assessment before GKRS treatment. In addition, no significant differences in tumor control rates or complications were found in the matched-control cohort analysis comparing GKRS for VS in patients with NF2 and GKRS for sporadic VS. These results show that GKRS is a valid treatment option for NF2-related VS, in addition to being a good option for sporadic VS, particularly in patients with the Feiling-Gardner phenotype and/or tumors that are small to medium in size. Larger tumors in patients with the Wishart phenotype appear to respond poorly to radiosurgery, and other treatment modalities should therefore be considered in such cases.
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Affiliation(s)
- Ivo J Kruyt
- 1Department of ENT, Donders Center for Neurosciences, Radboudumc, Nijmegen; and
| | - Jeroen B Verheul
- 2Gamma Knife Center Tilburg, St. Elisabeth Hospital, Tilburg, The Netherlands
| | | | - Henricus P M Kunst
- 1Department of ENT, Donders Center for Neurosciences, Radboudumc, Nijmegen; and
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Gamma Knife radiosurgery for neurofibromatosis type 2-associated meningiomas: a 22-year patient series. J Neurooncol 2016; 130:553-560. [PMID: 27816997 DOI: 10.1007/s11060-016-2257-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/27/2016] [Indexed: 10/20/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a debilitating genetic condition with potential development of multiple meningiomas. We report our experience treating a series of NF2-associated intracranial meningiomas with Gamma Knife radiosurgery (GKRS). Between 1992 and 2013, 15 consecutive patients (age 20-54 years) with 62 intracranial meningiomas were treated with single-fraction GKRS. Fifty-five percent of tumors involved the convexity or parasagittal/falx. The median prescription dose was 16 Gy (range 13-20 Gy). The median tumor diameter was 2.1 cm (range 0.7-4.5 cm). The median radiographic and clinical follow-up periods were 103 and 111 months, respectively. The 5-year and 10-year local controls were both 96 %. The disease specific survival was 93 % at 5 years and 68 % at 10 years. Fifty-three percent of patients had multiple meningiomas and received multiple GKRS treatments (range 1-7) for new or enlarging intracranial meningiomas. 11 (73 %) patients were alive at last follow-up, with 60 (97 %) tumors controlled (smaller or unchanged in size). There were 2 in-field failures, one at 1 year and the other at 3.5 years. There were no marginal failures. Major Complications after GKRS included: 1 case of radiation necrosis, 1 case of post treatment edema, and 1 case of a presumed radiation induced cavernous malformation 5 years after GKRS. GK is an effective treatment for enlarging NF2-associated meningiomas. No cases of malignant transformation or secondary malignancies were seen during the follow-up period.
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Yamanaka R, Hayano A, Kanayama T. Radiation-induced gliomas: a comprehensive review and meta-analysis. Neurosurg Rev 2016; 41:719-731. [DOI: 10.1007/s10143-016-0786-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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Abstract
The etiology of most childhood cancer remains largely unknown, but is likely attributable to random or induced genetic aberrations in somatic tissue. However, a subset of children develops cancer in the setting of an underlying inheritable condition involving a germline genetic mutation or chromosomal aberration. The term "neurocutaneous syndrome" encompasses a group of multisystem, hereditary disorders that are associated with skin manifestations as well as central and/or peripheral nervous system lesions of variable severity. This review outlines the central nervous system tumors associated with underlying neurocutaneous disorders, including neurofibromatosis type 1, neurofibromatosis type 2, schwannomatosis, tuberous sclerosis complex, Von Hippel Lindau, and nevoid basal cell carcinoma syndrome. Recognizing the presence of an underlying syndrome is critically important to both optimizing clinical care and treatment as well as genetic counseling and monitoring of these affected patients and their families.
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Affiliation(s)
- Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital and Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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10
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Temporal Lobe Gliosarcoma After Gamma Knife Radiosurgery for Vestibular Schwannoma. Otol Neurotol 2016; 37:1143-7. [DOI: 10.1097/mao.0000000000001112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Evaluation of Reported Malignant Transformation of Vestibular Schwannoma: De Novo and After Stereotactic Radiosurgery or Surgery. Otol Neurotol 2016; 36:1301-8. [PMID: 26134937 DOI: 10.1097/mao.0000000000000801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To critically analyze each reported case of malignant transformation of vestibular schwannoma (VS) after either stereotactic radiosurgery (SRS) or microsurgery (MS). DATA SOURCES We searched the Pubmed/Medline database using the relevant key words vestibular schwannoma, acoustic neuroma, malignant, transformation, radiation, induced, stereotactic, radiosurgery, malignancy, GammaKnife, and CyberKnife and combinations thereof. STUDY SELECTION Inclusion criteria for malignant transformation of VS after SRS included histopathology of initially benign VS, subsequent histopathology confirming malignant VS, reasonable latency period between malignancy and benign diagnoses. DATA EXTRACTION A neurotologist and a skull base neurosurgeon independently assessed each case report for quality, entry, exclusion criteria, and comparability of extracted data. DATA SYNTHESIS We calculated median age, latency times, and survival times for each case report. RESULTS Malignant transformation has been documented to occur after either SRS or MS. Eight cases were included that showed histopathologic evidence of malignant transformation after SRS and MS. Four cases of malignant transformation were included that demonstrated malignant transformation after MS only. Malignant transformation of VS can also occur de novo, and de novo malignant VSs are also encountered, which can confound a causal inference from either SRS or MS. Eighteen cases of primary malignant VS were included. Studies that were identified but not included in the review are summarized and tabulated. We found 12 studies of malignant transformation associated with NF2. CONCLUSION The potential mechanism leading to malignant transformation of VS seems more obvious for SRS and is less understood for MS. Given a low incidence of de novo malignant schwannoma, the possibility that these are spontaneous events in either setting cannot be ruled out. Risk of malignant transformation of VS after either SRS or MS is not zero; however, the magnitude of this risk is probably minimal based on the evidence from eight histopathologically confirmed cases.
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Surgical management of medium and large petroclival meningiomas: a single institution's experience of 199 cases with long-term follow-up. Acta Neurochir (Wien) 2016; 158:409-25; discussion 425. [PMID: 26743917 DOI: 10.1007/s00701-015-2671-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Petroclival meningiomas (PCMs) were once regarded as 'inoperable' due to their complex anatomy and limited surgical exposure. This study aimed to evaluate the long-term outcomes of surgically treated PCMs larger than 2 cm. METHODS A series of 199 consecutive patients (137 females, 68.8 %) with PCMs larger than 2 cm from between 1993 and 2003 were included. The clinical charts, radiographs, and follow-ups were evaluated. RESULTS Gross total resection (GTR) was achieved in 111 (55.8 %) patients, subtotal resection (STR) in 65, and partial resection (PR) in 23. Cranial nerve dysfunctions were the most common complications and occurred in 133 (66.8 %) cases. The surgical mortality was 2.0 %. The Karnofsky Performance Scale (KPS) scores significantly decreased 1 month after the operations (preoperative KPS = 76.8 and postoperative KPS = 64.8; p = 0.011, Paired-samples t test). Long-term follow-ups were obtained in 142 patients, the follow-up duration was 171.6 months, and the most recent KPS was 83.2. Permanent morbidities remained in 24 patients (18.9 %). Multivariate analysis revealed that brainstem edema and tumors larger than 4 cm in diameter were independent risk factors in terms of outcomes (KPS < 80). The recurrence/progression rates were 14.5, 31.8, and 53.3 % for the GTR, STR, and PR cases, respectively (p = 0.002, Pearson χ (2) test). Gamma Knife radiosurgery for the remnants exhibited good tumor control. CONCLUSIONS Favorable outcomes and low mortality were achieved with the microsurgical management of medium and large PCMs; however, the rates of cranial nerves dysfunction remained high. Radically aggressive resection might not be judicious in terms of postoperative morbidity. The preoperative evaluations and intraoperative findings were informative regarding the outcomes. The low follow-up rate likely compromised our findings, and additional consecutive studies were required.
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Glioma radioinducido secundario a tratamiento radioquirúrgico de un schwannoma del nervio vestibular. Neurocirugia (Astur) 2016; 27:33-7. [DOI: 10.1016/j.neucir.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022]
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McCabe MG, Evans DG. Pathogenesis and management of type 2 neurofibromatosis. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1014800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mallory GW, Pollock BE, Foote RL, Carlson ML, Driscoll CL, Link MJ. Stereotactic Radiosurgery for Neurofibromatosis 2—Associated Vestibular Schwannomas. Neurosurgery 2013; 74:292-300; discussion 300-1. [DOI: 10.1227/neu.0000000000000264] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Management of neurofibromatosis type 2 (NF2)—associated vestibular schwannomas (VSs) remains controversial. Stereotactic radiosurgery (SRS) with conventional dosing is less effective for NF2-related VS compared with sporadic lesions.
OBJECTIVE:
To evaluate optimal SRS dose parameters for NF2-related VS and to report long-term outcomes.
METHODS:
A prospective database was reviewed and outcome measures, including radiographic progression, American Academy of Otolaryngology—Head and Neck Surgery hearing class, and facial nerve function, were analyzed. Progression-free survival was estimated with Kaplan-Meier methods. Associations between tumor progression and radiosurgical treatment parameters, tumor volume, and patient age were explored with the use of Cox proportional hazards regression.
RESULTS:
Between 1990 and 2010, 26 patients with 32 NF2-related VSs underwent SRS. Median marginal dose and tumor volume were 14 Gy and 2.7 cm3, respectively. Twenty-seven tumors (84%) showed no growth (median follow-up, 7.6 years). Kaplan-Meier estimates for 5- and 10-year progression-free survival were 85% and 80%, respectively. Cox proportional hazards demonstrated a significant inverse association between higher marginal doses and tumor progression (hazard ratio, 0.49; 95% confidence interval, 0.17-0.92; P = .02). Audiometric data were available in 30 ears, with 12 having class A/B hearing before SRS. Only 3 maintained serviceable hearing at the last follow-up. Four underwent cochlear implantation. Initially, 3 achieved open-set speech recognition, although only 1 experienced long-term benefit. Facial nerve function remained stable in 50% of cases.
CONCLUSION:
Higher marginal doses than commonly prescribed for sporadic VS were associated with improved tumor control in patients with NF2. Hearing outcomes were poor even when contemporary reduced marginal doses were used. However, SRS allows an anatomically preserved cochlear nerve and may permit hearing rehabilitation with cochlear implantation. Further consideration should be given to optimum dosing to achieve long-term control while maximizing functional outcomes.
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Affiliation(s)
- Grant W. Mallory
- Departments of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Bruce E. Pollock
- Departments of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
- Radiation Oncology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Robert L. Foote
- Radiation Oncology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Matthew L. Carlson
- Otolaryngology—Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Colin L. Driscoll
- Departments of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
- Otolaryngology—Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Michael J. Link
- Departments of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
- Otolaryngology—Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
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Patel TR, Chiang VLS. Secondary neoplasms after stereotactic radiosurgery. World Neurosurg 2013; 81:594-9. [PMID: 24148883 DOI: 10.1016/j.wneu.2013.10.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The use of medical radiation has increased 6-fold in the past 30 years. Within neurosurgery, the advent of stereotactic radiosurgery (SRS) has significantly altered the treatment paradigm for both benign and malignant central nervous system diseases. With this increased reliance on radiation has come a responsibility to identify the long-term risks, including the potential development of radiation-induced neoplasms. Although the data regarding traditional radiation exposure and its subsequent risks are well-defined, the data for SRS is less developed. METHODS We reviewed the published literature to more accurately define the risk of developing secondary neoplasms after stereotactic radiosurgery. RESULTS A total of 36 cases of SRS-induced neoplasms were identified. More than half of the cases had an initial diagnosis of vestibular schwannoma. Overall, the risk of developing an SRS-induced neoplasm is approximately 0.04% at 15 years. CONCLUSION The risk of developing an SRS-induced neoplasm is low but not zero. Thus, long-term surveillance imaging is advised for patients treated with SRS.
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Affiliation(s)
- Toral R Patel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronica L S Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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Husseini ST, Piccirillo E, Sanna M. On "malignant transformation of acoustic neuroma/vestibular schwannoma 10 years after gamma knife stereotactic radiosurgery" (skull base 2010;20:381-388). Skull Base 2012; 21:135-8. [PMID: 22451815 DOI: 10.1055/s-0031-1275258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hagel C, Stemmer-Rachamimov AO, Bornemann A, Schuhmann M, Nagel C, Huson S, Evans DG, Plotkin S, Matthies C, Kluwe L, Mautner VF. Clinical presentation, immunohistochemistry and electron microscopy indicate neurofibromatosis type 2-associated gliomas to be spinal ependymomas. Neuropathology 2012; 32:611-6. [DOI: 10.1111/j.1440-1789.2012.01306.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beitner MM, Winship I, Drummond KJ. Neurosurgical considerations in von Hippel-Lindau disease. J Clin Neurosci 2011; 18:171-80. [PMID: 21215639 DOI: 10.1016/j.jocn.2010.04.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 04/03/2010] [Indexed: 10/18/2022]
Abstract
Von Hippel-Lindau disease is an inherited syndrome predisposing to a variety of benign and malignant neoplasms of the central nervous system and viscera that requires comprehensive screening and follow-up of individuals and their families. As such, it is important for the neurosurgeon to be aware of its clinical features and management issues. In this article we review the clinical aspects, management and surveillance of von Hippel-Lindau disease for neurosurgical practice.
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Affiliation(s)
- M M Beitner
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Elvsåshagen T, Solyga V, Bakke SJ, Heiberg A, Kerty E. [Neurofibromatosis type 2 and auditory brainstem implantation]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1469-73. [PMID: 19690597 DOI: 10.4045/tidsskr.08.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is a rare and severe autosomal dominant disorder caused by mutations in a tumour suppressor gene. This article reviews NF2 and its treatment with auditory brainstem implantation. MATERIAL AND METHODS The review is based on the authors' experience with the disease and literature identified through a non-systematic search of PubMed. RESULTS NF2 is caused by loss-of-normal function of the tumour suppressor protein merlin. Merlin normally suppresses cell growth and proliferation. The clinical picture is dominated by neurological symptoms, caused by multiple tumours - mainly schwannomas and meningeomas. The hallmark of the disease is development of bilateral vestibular schwannomas, and the most common presenting symptom in adults is progressive hearing loss. Presenile cataract, ocular motility disorders, peripheral neuropathy and skin tumours are other common findings. The majority of patients become deaf, many patients become severely disabled and life expectancy is reduced. The goal of management is conservation of function and maintenance of quality of life. Auditory brainstem implants stimulate the cochlear nucleus directly and provide substantial auditory benefits to patients with NF2. INTERPRETATION A multidisciplinary approach in specialty centres is recommended. Management by an experienced team reduces mortality and improves outcome after surgery. Auditory brainstem implantation is an important part of the hearing rehabilitation in these patients. Emerging knowledge of the molecular disease mechanisms offers hope for new therapeutic strategies.
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Affiliation(s)
- Torbjørn Elvsåshagen
- Avdeling for nevropsykiatri og psykosomatisk medisin, Nevroklinikken, Oslo universitetssykehus, Rikshospitalet 0027 Oslo og Institutt for psykiatri Det medisinske fakultet, Universitetet i Oslo, Norway.
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Niranjan A, Kondziolka D, Lunsford LD. Neoplastic Transformation After Radiosurgery or Radiotherapy: Risk and Realities. Otolaryngol Clin North Am 2009; 42:717-29. [DOI: 10.1016/j.otc.2009.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Neurofibromatosis type 2 is an autosomal-dominant multiple neoplasia syndrome that results from mutations in the NF2 tumour suppressor gene located on chromosome 22q. It has a frequency of one in 25,000 livebirths and nearly 100% penetrance by 60 years of age. Half of patients inherit a germline mutation from an affected parent and the remainder acquire a de novo mutation for neurofibromatosis type 2. Patients develop nervous system tumours (schwannomas, meningiomas, ependymomas, astrocytomas, and neurofibromas), peripheral neuropathy, ophthalmological lesions (cataracts, epiretinal membranes, and retinal hamartomas), and cutaneous lesions (skin tumours). Optimum treatment is multidisciplinary because of the complexities associated with management of the multiple, progressive, and protean lesions associated with the disorder. We review the molecular pathogenesis, genetics, clinical findings, and management strategies for neurofibromatosis type 2.
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Affiliation(s)
- Ashok R Asthagiri
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1414, USA.
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Ullrich NJ. Inherited disorders as a risk factor and predictor of neurodevelopmental outcome in pediatric cancer. ACTA ACUST UNITED AC 2009; 14:229-37. [PMID: 18924162 DOI: 10.1002/ddrr.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Each year in the United States, an average of one to two children per 10,000 develop cancer. The etiology of most childhood cancer remains largely unknown but is likely attributable to random or induced genetic aberrations in somatic tissue. However, a subset of children develops cancer in the setting of an underlying inheritable condition involving a germline genetic mutation or chromosomal aberration. Despite overall improved survival rates for children with cancer over recent decades, many patients experience neurological and neurocognitive complications during the course of their illness and/or as late effects of treatment. Improvements in therapy, longer survival times, and improved imaging techniques have all increased both the time that patients are at risk and the ability to detect such complications. How an underlying inherited disorder influences the incidence, timing, etiology, and treatment of such sequelae has not been extensively documented, but evidence exists for an increased risk for secondary malignancies and in some cases life-threatening sensitivity/toxicity to conventionally dosed cancer treatments, thus emphasizing the need for the early recognition of such syndromes. This review outlines the major tumor- and treatment-related neurodevelopmental sequelae in pediatric cancer patients, with particular attention to children with an underlying inheritable disorder.
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Affiliation(s)
- Nicole J Ullrich
- Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Parsons CM, Canter RJ, Khatri V. Surgical Management of Neurofibromatosis. Surg Oncol Clin N Am 2009; 18:175-96, x. [DOI: 10.1016/j.soc.2008.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2. Cancer 2008; 115:390-8. [DOI: 10.1002/cncr.24036] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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