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Yao L, Wang B, Lu F, He X, Lu G, Zhang S. Facial nerve in skullbase tumors: imaging and clinical relevance. Eur J Med Res 2023; 28:121. [PMID: 36918971 PMCID: PMC10012458 DOI: 10.1186/s40001-023-01078-7] [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: 04/28/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Facial nerve, the 7th cranial nerve, is a mixed nerve composed of sensory and motor fibers, and its main branch is situated in the cerebellopontine angle. Facial nerve dysfunction is a debilitating phenomenon that can occur in skullbase tumors and Bell's pals. Recovery of the facial nerve dysfunction after surgery for skullbase tumors can be disappointing, but is usually favorable in Bell's palsy. Advances in magnetic resonance imaging (MRI) allow to visualize the facial nerve and its course in the cerebellopontine angle, also when a large tumor is present and compresses the nerve. Here, we describe the anatomical, neurochemical and clinical aspects of the facial nerve and highlight the recent progress in visualizing the facial nerve with MRI.
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Affiliation(s)
- Longping Yao
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.,Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Baoyan Wang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Fengfei Lu
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xiaozheng He
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Guohui Lu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Shizhong Zhang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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Aftahy AK, Groll M, Wagner A, Barz M, Bernhardt D, Combs SE, Meyer B, Gempt J, Negwer C. Schwannomas of the greater superficial petrosal nerve - case series, discussion of surgical techniques, and review of literature. BMC Neurol 2022; 22:470. [PMID: 36494617 PMCID: PMC9733176 DOI: 10.1186/s12883-022-02960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas account for about 0.8% of all petrous mass lesions. Schwannomas of the greater superficial petrosal nerve (GSPN) are a rare subtype with few case-reports up to date. CASE PRESENTATIONS A retrospective analysis of clinical outcomes, radiographic findings and postoperative complication between June 2007 and December 2020 was performed. Four cases of GSPN schwannomas were reported. The presenting symptoms were facial nerve palsy and hearing loss. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone, in one case with extraordinary petrous bone and mastoid infiltration and destruction. Three cases were removed through a subtemporal extra- or intradural approach, one case via a combined pre- and retrosigmoid approach. Improvement of facial nerve palsy occurred in one case; new hearing loss was observed in another case. Xeropthalmia was a short-term temporary deficit in three cases. Short- to mid-term follow-up of the patients has not shown any tumor recurrence. CONCLUSIONS GSPN schwannomas are rare entities presenting with heterogenous symptoms. Our surgical findings emphasize safe resection. Complete remission is possible by GTR. Since the small data set limits the expressiveness of statements regarding standard of care and alternative therapy options, additional data is needed.
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Affiliation(s)
- A. Kaywan Aftahy
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Maximilian Groll
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Arthur Wagner
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Melanie Barz
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Denise Bernhardt
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Radio-Oncology, Technical University Munich, Munich, Germany
| | - Stephanie E. Combs
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Radio-Oncology, Technical University Munich, Munich, Germany
| | - Bernhard Meyer
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Jens Gempt
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Chiara Negwer
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
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3
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Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma. Otol Neurotol 2022; 43:e841-e845. [PMID: 35900912 DOI: 10.1097/mao.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In the current era of modern neurosurgery, the treatment strategies have been shifted to "nerve-preservation approaches" for achieving a higher facial and hearing function preservation rate following facial nerve tumors. We have conducted this novel report on determining the outcome of patients with facial nerve schwannomas (FNS) treated with hypofractionated stereotactic radiosurgery (hfSRS). PATIENTS Retrospective chart review of a prospectively maintained database search was conducted. INTERVENTION Patients who underwent hfSRS CyberKnife (Accuray Inc, Sunnyvale, CA, U.S.A.) for FNS were included. MAIN OUTCOME MEASURES Outcomes consisted of tumor control, facial and hearing nerve function as graded by House-Brackmann and American Academy of Otolaryngology-Head and Neck Surgery recommendations, and adverse radiation effects. RESULTS With an institutional board review approval, we retrospectively identified five patients with FNS (four intracranial [80%] and one extracranial [20%]) treated with hfSRS (2011-2019). Patients received definitive SRS in three patients (60.0%), whereas adjuvant to surgical resection in two patients (40.0%). A median tumor volume of 7.5 cm3 (range, 1.5-19.6 cm3) received a median prescription dose of 23.2 Gy (range, 21-25 Gy) administered in median of three fractions (range, three to five sessions). With a median radiographic follow-up of 31.4 months (range, 13.0-71.0 mo) and clinical follow-up of 32.6 months (range, 15.1-72.0 mo), the local tumor control was 100.0%. At the last clinical follow-up, the facial nerve function improved or remained unchanged House-Brackmann I-II in 80.0% of the patients, whereas the hearing nerve function improved or remained stable in 100.0% of the patients. Temporary clinical toxicity was observed in three patients (60.0%), which resolved. None of the patients developed adverse radiation effect. CONCLUSION From our case series, hfSRS in FNS seems to be safe and efficacious in terms of local tumor control, and improved facial and hearing nerve function.
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4
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Less common extracerebral tumors. PROGRESS IN BRAIN RESEARCH 2022; 268:279-302. [PMID: 35074086 DOI: 10.1016/bs.pbr.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter examines the results of GKNS on a variety of extraparenchymal skull base tumors some benign and some malignant. For the benign tumors there is good evidence on the effectiveness of the method for pretty much all diagnoses. For malignant extraparenchymal tumors the results are more limited and GKNS only has a supportive role in these lesions.
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5
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Rotter J, Lu VM, Graffeo CS, Perry A, Driscoll CLW, Pollock BE, Link MJ. Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression. J Neurosurg 2021; 135:542-553. [PMID: 33126214 DOI: 10.3171/2020.6.jns201548] [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: 04/30/2020] [Accepted: 06/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis. METHODS A search of the Ovid EMBASE, PubMed, SCOPUS, and Cochrane databases from inception to July 2019 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. Facial nerve outcomes were classified as improved, stabilized, or worsened by last follow-up. Incidence was pooled by random-effects meta-analysis of proportions. RESULTS Thirty-three articles with a pooled cohort of 519 patients with FNS satisfied all criteria. Twenty-five articles described operative outcomes in 407 (78%) patients; 10 articles reported SRS outcomes in 112 (22%). In the surgical cohort, facial nerve function improved in 23% (95% CI 15%-32%), stabilized in 41% (95% CI 32%-50%), and worsened in 30% (95% CI 21%-40%). In the SRS cohort, facial nerve function was improved in 20% (95% CI 9%-34%), stable in 66% (95% CI 54%-78%), and worsened in 9% (95% CI 3%-16%). Compared with SRS, microsurgery was associated with a significantly lower incidence of stable facial nerve function (p < 0.01) and a significantly higher incidence of worsened facial nerve function (p < 0.01). Tumor progression and complication rates were comparable. Outcome certainty assessments were very low to moderate for all parameters. CONCLUSIONS Unfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.
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Affiliation(s)
| | | | | | | | | | - Bruce E Pollock
- Departments of1Neurosurgery
- 3Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Departments of1Neurosurgery
- 2Otolaryngology-Head and Neck Surgery, and
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Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021; 88:E91-E98. [PMID: 32687577 DOI: 10.1093/neuros/nyaa313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | - Gregory P Lekovic
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | | | | | - Hao Long
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Monica Mureb
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nasser Mohammed
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Dusan Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Krishna C Joshi
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
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7
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Uppar AM, Rao S, Prasad C, Arimappamagan A, Santosh V. Schwannoma of the Greater Superficial Petrosal Nerve: An Unusual Site for a Common Tumor. J Neurol Surg A Cent Eur Neurosurg 2020; 81:565-570. [PMID: 32361981 DOI: 10.1055/s-0039-1685168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Greater superficial petrosal nerve (GSPN) schwannoma is a rare clinical entity. It forms a small subset of the larger group of facial nerve schwannomas. A thorough literature search yielded only 27 such cases reported to date in the English literature. We present one such rare case of GSPN schwannoma and discuss the clinical spectrum and management along with a review of the literature. We demonstrate the surgical steps in an operative video.
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Affiliation(s)
- Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Chandrajit Prasad
- NIIR, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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8
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Bartindale M, Heiferman J, Joyce C, Anderson D, Leonetti J. Facial Schwannoma Management Outcomes: A Systematic Review of the Literature. Otolaryngol Head Neck Surg 2020; 163:293-301. [PMID: 32228141 DOI: 10.1177/0194599820913639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. DATA SOURCES PubMed-National Center for Biotechnology Information and Scopus databases. REVIEW METHODS A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. RESULTS Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. CONCLUSION The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.
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Affiliation(s)
- Matthew Bartindale
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey Heiferman
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Cara Joyce
- Clinical Research Office, Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Douglas Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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9
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Bartindale M, Heiferman J, Joyce C, Balasubramanian N, Anderson D, Leonetti J. The Natural History of Facial Schwannomas: A Meta-Analysis of Case Series. J Neurol Surg B Skull Base 2018; 80:458-468. [PMID: 31534886 DOI: 10.1055/s-0038-1675590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/23/2018] [Indexed: 12/20/2022] Open
Abstract
Objective This study is to establish predictors of facial paralysis and auditory morbidity secondary to facial schwannomas by assimilating individualized patient data from the literature. Design A systematic review of the literature was conducted for studies regarding facial schwannomas. Studies were only included if they presented patient level data, House-Brackmann grades, and tumor location by facial nerve segment. Odds ratios (OR) were estimated using generalized linear mixed models. Main Outcome Measures Facial weakness and hearing loss. Results Data from 504 patients were collected from 32 studies. The geniculate ganglion was the most common facial nerve segment involved (39.3%). A greater number of facial nerve segments involved was positively associated with both facial weakness and hearing loss, whereas tumor diameter did not correlate with either morbidity. Intratemporal involvement was associated with higher odds of facial weakness (OR = 4.78, p < 0.001), intradural involvement was negatively associated with facial weakness (OR = 0.56, p = 0.004), and extratemporal involvement was not a predictor of facial weakness (OR = 0.68, p = 0.27). The odds of hearing loss increased with more proximal location of the tumor (intradural: OR = 3.26, p < 0.001; intratemporal: OR = 0.60, p = 0.14; extratemporal: OR = 0.27, p = 0.01). Conclusion The most important factors associated with facial weakness and hearing loss are tumor location and the number of facial nerve segments involved. An understanding of the factors that contribute most heavily to the natural morbidity can help guide the appropriate timing and type of intervention in future cases of facial schwannoma.
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Affiliation(s)
- Matthew Bartindale
- Depaent of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jeffrey Heiferman
- Depaent of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Cara Joyce
- Clinical Research Office, Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois
| | - Neelam Balasubramanian
- Clinical Research Office, Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois
| | - Douglas Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | - John Leonetti
- Depaent of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
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10
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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.
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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
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