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Bouttelgier RM, Berghe CV, Vantomme N, Cambron M, Casselman JW. Imaging of trochlear nerve schwannomas: a case series and systematic review of the literature. Br J Neurosurg 2023:1-7. [PMID: 37966054 DOI: 10.1080/02688697.2023.2280601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Abstract
Purpose Trochlear nerve schwannomas are rare tumors. So far, only 121 cases have been published. We present four new cases, discuss the imaging characteristics and summarize all previously published cases through a systematic review.Methods Four cases, all treated in AZ Sint-Jan Hospital Brugge-Oostende (Belgium), were collected, including their demographic, clinical and radiological data. All MR imaging was performed with the three-dimensional fluid-attenuated inversion recovery (3D-FLAIR), turbo spin echo T1 high-resolution (TSE T1 HR), three-dimensional balanced fast-field echo (3D b-FFE) and three-dimensional T1 black blood (3D T1 black blood) sequence. We compared our findings with the present literature through a systematic literature review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Screening with routine unenhanced 3D-FLAIR imaging could identify all schwannomas as hyperintense lesions on the course of the trochlear nerve. The use of 3D T1 black blood sequences was superior in depicting the lesions, while high-resolution 3D b-FFE images enabled us to visualize the anatomic boundaries of the lesions in detail. Most trochlear schwannomas are located in the ambient cistern, at or just below the free edge of the tentorium.Conclusion The majority of trochlear nerve schwannomas are located cisternal and display variable enhancement on contrast administration. 3D-FLAIR imaging is superior in detecting these lesions. Comparison with data collected from previous cases demonstrates the importance of early diagnosis and treatment. Generally, patients with trochlear nerve schwannomas have a good prognosis.
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Affiliation(s)
| | | | - Nikolaas Vantomme
- Department of Neurosurgery, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Melissa Cambron
- Department of Neurology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
| | - Jan W Casselman
- Department of Radiology, AZ Sint-Jan Hospital, Brugge-Oostende, Belgium
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Bezborodova TY, Zolotova SV. [Trigeminal neuromas: modern diagnosis and treatment]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:104-110. [PMID: 36763561 DOI: 10.17116/neiro202387011104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Trigeminal neuroma (TN) is a benign neoplasm arising from trigeminal nerve sheath. The tumor can grow from any part of the nerve from the root in posterior cranial fossa to peripheral extracranial branches. Symptoms of trigeminal neuroma are variable and usually depend on location and dimensions of tumor. We present a review devoted to the problem of TN. Surgery was the only possible option in patients with TN for a long time. However, radiotherapy became one of the options and sometimes alternative to surgical treatment since the late 1980s. Besides active management of patients with TN, follow-up with regular radiographic control of small asymptomatic tumors also seems to be reasonable. When evaluating treatment outcomes, physicians consider quality of life and return to previous work and activity in addition to resection quality, neurological impairment, relapse-free period and tumor growth control. However, assessment of these indicators after certain treatment is rare. Thus, it is difficult to determine treatment strategy with maximum ratio of effectiveness and quality of life. Therefore, optimization of TN treatment is currently an urgent problem that requires further study.
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Hong S, Kagawa K, Sato K, Nomura R, Ichi S. The Treatment Outcome of CyberKnife-Based Stereotactic Radiotherapy for Intracranial and Extracranial Nonvestibular Schwannomas: A Single-Center Experience. World Neurosurg 2022; 164:e1200-e1208. [PMID: 35660671 DOI: 10.1016/j.wneu.2022.05.132] [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: 04/26/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on the outcomes of CyberKnife-based hypofractionated stereotactic radiosurgery (hSRS) for intracranial and extracranial nonvestibular schwannomas (nVSs) are not sufficient. METHODS Patients who underwent hSRS for nVSs between 2010 and 2019 were retrospectively reviewed. RESULTS A total of 39 patients with 39 nVSs were identified. The mean age was 53 (±18) years, and 20 patients (51%) were women. Twenty-five patients (64%) had previous surgeries. Seventeen patients (44%) had nVSs extending outside the cranium. The mean prescribed dose covering 95% of the planning target volume was 22 Gy (±3.7 Gy), the mean fractionation was 4 (±2), and the mean target volume was 13 cm3 (±16 cm3). The radiological tumor control rate was 100% during the mean follow-up period of 67 months (±37 months). Thirty-seven patients (95%) were clinically stable during the mean follow-up period of 72 months (±35 months). Nine patients (23%) suffered from transient adverse radiation effects (AREs), including transient tumor expansion, and 2 (5%) suffered from permanent AREs. CONCLUSIONS We summarized the treatment outcomes of hSRS for nVSs. Although all patients achieved radiological tumor control, the risk of either transient or permanent ARE was high. Therefore, it is necessary to monitor patients for clinical deterioration due to AREs.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Kenji Kagawa
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kengo Sato
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ryutaro Nomura
- CyberKnife Center, Chigasaki Chuo Hospital, Kanagawa, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Part I: oculomotor and other rare non-vestibular schwannomas (I, II, III, IV, VI). Acta Neurochir (Wien) 2022; 164:285-297. [PMID: 34755208 DOI: 10.1007/s00701-021-05048-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogeneous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the first of a three-part series describing non-vestibular schwannomas (I, II, III, IV, VI). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management of these patients is complex, and for those which are symptomatic tumours, the paradigm is shifting towards the compromise between function preservation and progression-free survival.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | | | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Pierre-Hugues Roche
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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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.
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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
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Langlois AM, Iorio-Morin C, Faramand A, Niranjan A, Lunsford LD, Mohammed N, Sheehan JP, Liščák R, Urgošík D, Kondziolka D, Lee CC, Yang HC, Atik AF, Mathieu D. Outcomes after stereotactic radiosurgery for schwannomas of the oculomotor, trochlear, and abducens nerves. J Neurosurg 2021; 135:1044-1050. [PMID: 33482633 DOI: 10.3171/2020.8.jns20887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial nerve (CN) schwannomas are intracranial tumors that are commonly managed by stereotactic radiosurgery (SRS). There is a large body of literature supporting the use of SRS for vestibular schwannomas. Schwannomas of the oculomotor nerves (CNs III, IV, and VI) are rare skull base tumors, occurring close to the brainstem and often involving the cavernous sinus. Resection can cause significant morbidity, including loss of nerve function. As for other schwannomas, SRS can be used to manage these tumors, but only a handful of cases have been published so far, often among reports of other uncommon schwannoma locations. METHODS The goal of this study was to collect retrospective multicenter data on tumor control, clinical evolution, and morbidity after SRS. This study was performed through the International Radiosurgery Research Foundation. Patients managed with single-session SRS for an oculomotor cranial nerve schwannoma (CN III, IV, or VI) were included. The diagnosis was based on diplopia or ptosis as the main presenting symptom and anatomical location on the trajectory of the presumed cranial nerve of origin, or prior resection confirming diagnosis. Demographic, SRS dose planning, clinical, and imaging data were collected from chart review of the treated patients. Chi-square and Kaplan-Meier analyses were performed. RESULTS Seven institutions submitted data for a total of 25 patients. The median follow-up time was 41 months. The median age at the time of treatment was 52 years. There were 11 CN III schwannomas, 11 CN IV schwannomas, and 3 CN VI schwannomas. The median target volume was 0.74 cm3, and the median marginal dose delivered was 12.5 Gy. After SRS, only 2 patients (including the only patient with neurofibromatosis type 2) had continued tumor growth. Crude local control was 92% (23/25), and the 10-year actuarial control was 86%. Diplopia improved in the majority of patients (11/21), and only 3 had worsening following SRS, 2 of whom also had worsened ptosis, both in the context of tumor progression. CONCLUSIONS SRS for schwannomas of the oculomotor, trochlear, and abducens nerves is effective and provides tumor control rates similar to those for other cranial nerve schwannomas. SRS allows improvement of diplopia in the majority of patients. SRS should therefore be considered as a first-line treatment option for oculomotor nerve schwannomas.
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Affiliation(s)
- Anne-Marie Langlois
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Christian Iorio-Morin
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Andrew Faramand
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Nasser Mohammed
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Roman Liščák
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Dušan Urgošík
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Douglas Kondziolka
- 5Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Cheng-Chia Lee
- 6Department of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan; and
| | - Huai-Che Yang
- 6Department of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan; and
| | - Ahmet F Atik
- 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Mathieu
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
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7
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Rooney MK, Golden DW, Byun J, Lukas RV, Sonabend AM, Lesniak MS, Sachdev S. Evaluation of patient education materials for stereotactic radiosurgery from high-performing neurosurgery hospitals and professional societies. Neurooncol Pract 2020; 7:59-67. [PMID: 32257285 DOI: 10.1093/nop/npz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content. Methods In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients' perspectives about SRS. Results Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019). Conclusion Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago.,Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, IL
| | - John Byun
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Rimas V Lukas
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maciej S Lesniak
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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Adherence of US Insurance Payer Policies to the American Society of Radiation Oncology Stereotactic Radiosurgery Model Policy. Pract Radiat Oncol 2020; 10:e250-e254. [PMID: 32004704 DOI: 10.1016/j.prro.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/22/2019] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The medical necessity of stereotactic radiosurgery (SRS) is nonuniform across insurance policies. The American Society for Radiation Oncology (ASTRO) created a model policy based on the consensus of the radiation oncology community to communicate medically necessary indications for SRS. We compared the current insurance policies for SRS with those of the ASTRO model policy. METHODS AND MATERIALS We identified 58 insurance payers and 3 national benefits managers with SRS policies. Among these, 7 insurance payers were excluded for policies that were not reviewed after 2015 and for not detailing individual medically necessary indications. For each of the indications listed in ASTRO's model policy, we determined the proportion of payers that considered SRS medically necessary. We compared these proportions for national versus regional payers and policies updated in the last 12 months versus those updated less often using Fisher exact and χ2 tests. RESULTS All insurance policies reviewed considered SRS as medically necessary for brain metastases, medically refractory trigeminal neuralgia, and arteriovenous malformations. Compared with national payers, regional payers were less likely to deem other schwannomas, and a boost for large cranial or spinal lesions medically necessary (P < .05). The indication with the lowest coverage was medically refractory movement disorders (44.4%), followed by medically refractory epilepsy (33.3%). However, policies that were updated within the last year were more likely to deem medical necessity for epilepsy, movement disorders, hemangioblastoma, pineal gland tumors, and other schwannomas. CONCLUSIONS Significant discrepancy remains among insurance policies for several indications in ASTRO's model policy for SRS; however, national payers and those with recent policy updates have a greater concordance with the ASTRO model policy.
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Park HR, Lee JM, Park KW, Kim JH, Jeong SS, Kim JW, Chung HT, Kim DG, Paek SH. Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma. Exp Neurobiol 2018; 27:245-255. [PMID: 30022876 PMCID: PMC6050410 DOI: 10.5607/en.2018.27.3.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea
| | - Kwang-Woo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Soon Jeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea.,Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea
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Langlois AM, Iorio-Morin C, Masson-Côté L, Mathieu D. Gamma Knife Stereotactic Radiosurgery for Nonvestibular Cranial Nerve Schwannomas. World Neurosurg 2017; 110:e1031-e1039. [PMID: 29223524 DOI: 10.1016/j.wneu.2017.11.163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonvestibular cranial schwannomas represent a rare type of benign intracranial tumor. Few studies have evaluated the use of stereotactic radiosurgery (SRS) as a primary management option for these lesions. We performed a retrospective review of our institution's experience focusing on efficacy with regard to tumor control and clinical symptom stabilization as well as treatment safety. METHODS Patients were included if they underwent at least 1 SRS procedure for a nonvestibular schwannoma and had at least 6 months of available imaging follow-up. Demographic, SRS dose planning, clinical, and imaging data were collected from chart reviews of treated patients. χ2 and Kaplan-Meier analyses were performed. RESULTS Between 2004 and 2016, 35 schwannomas were treated in 34 patients. Median follow-up was 48 months. Median age at time of treatment was 51 years. Three patients had neurofibromatosis 2. Schwannoma location was trigeminal (57%), facial (20%), jugular foramen (14%), abducens (6%), and trochlear (3%). Median margin dose delivered was 13 Gy. The 5-year and 10-year tumor control rates were 94.4% and 88.5%, respectively. Presenting clinical symptoms stabilized or improved in 79% of cases after radiosurgery, and new or worsening symptoms were seen in 21%. CONCLUSIONS SRS is a safe and effective modality for treatment of nonvestibular cranial nerve schwannomas.
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Affiliation(s)
- Anne-Marie Langlois
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Laurence Masson-Côté
- Department of Radiation-Oncology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - David Mathieu
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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11
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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.
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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
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Pediatric neurofibromatosis type 2: clinical and molecular presentation, management of vestibular schwannomas, and hearing rehabilitation. Childs Nerv Syst 2016; 32:2403-2413. [PMID: 27704245 DOI: 10.1007/s00381-016-3257-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/19/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aims to describe the clinical and molecular presentation of pediatric neurofibromatosis type 2 (NF2) and the subsequent management of vestibular schwannomas (VS) and hearing rehabilitation. METHODS This is a single-center retrospective study of neurofibromatosis type 2 diagnosed before the age of 18 years old from 1997. Natural history of vestibular schwannomas and surgical outcomes were evaluated using volumetric MRI, hearing, and facial nerve assessment. Patients included in chemotherapy protocols were excluded. RESULTS From a database of 80 patients followed up for NF2 on a regular basis, 25 patients were eligible (11 sporadic cases, 14 inherited in five families). The mean age at diagnosis was 11.6 years old. The average clinical follow-up was 6.5 years. NF2 mutation was identified in 81 % of the probands. The average growth rate based on the maximum linear diameter (DGR) was 1.68 mm/year (n = 33, average follow-up 4.22 years) and 545 mm3/year in volumetric assessment (VGR) for VS larger than 1 cm (n = 21, average follow-up 3.4 years). In unoperated ears, hearing was stable in about 50 % of ears. The mean change in dB HL was 9.5 dB/year for pure-tone average and 3.5 for speech-recognition threshold (n = 34, 5.5 years 1-12). Eight children required removal through a translabyrinthine approach (mean follow-up was 4.5 years), six patients were operated on for hearing preservation (mean postoperative follow-up 4.3 years). Six patients were eligible for hearing rehabilitation with cochlear implantation (I), and five received placement of an auditory brainstem implant. CONCLUSION Early diagnosis and treatment of small growing VS should be carefully discussed considering familial history and possible rehabilitation with a CI.
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D'Astous M, Ho AL, Pendharkar A, Choi CYH, Soltys SG, Gibbs IC, Tayag AT, Thompson PA, Adler JR, Chang SD. Stereotactic radiosurgery for non-vestibular cranial nerve schwanommas. J Neurooncol 2016; 131:177-183. [PMID: 27752881 DOI: 10.1007/s11060-016-2286-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
Non-vestibular cranial nerve schwannomas (NVCNS) are rare lesions, representing <10 % of cranial nerve schwannomas. The optimal treatment for NVCNS is often derived from vestibular schwannomas experience. Surgical resection has been referred to as the first line treatment for those benign tumors, but significant complication rates are reported. Stereotactic radiosurgery (SRS) has arisen as a mainstay of treatment for many benign tumors, including schwanommas. We retrospectively reviewed the outcomes of NVCNS treated by SRS to characterize tumor control, symptom relief, toxicity, and the role of hypo-fractionation of SRS dose. Eighty-eight (88) patients, with ninety-five (95) NVCNS were treated with either single or multi-session SRS from 2001 to 2014. Local control was achieved in 94 % of patients treated (median follow-up of 33 months, range 1-155). Complications were seen in 7.4 % of cases treated with SRS. At 1-year, 57 % of patients had improvement or resolution of their symptoms, while 35 % were stable and 8 % had worsening or increased symptoms. While 42 % received only one session, results on local control were similar for one or multiple sessions (p = 0.424). SRS for NVCNS is a treatment modality that provides excellent local control with minimal complication risk compared to traditional neurosurgical techniques. Tumor control obtained with a multi-session treatment was not significantly different from single session treatment. Safety profile was also comparable for uni or multi-session treatments. We concluded that, as seen in VS treated with CK SRS, radiosurgery treatment can be safely delivered in cases of NVCNS.
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Affiliation(s)
- Myreille D'Astous
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA.
- Department of Surgery, CHU de Québec, Université Laval, Quebec City, QC, Canada.
| | - Allen L Ho
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Arjun Pendharkar
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Clara Y H Choi
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Armine T Tayag
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Patricia A Thompson
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - John R Adler
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University Medical Center, Stanford Cancer Institute, Stanford, CA, USA
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Hasegawa T, Kato T, Kida Y, Hayashi M, Tsugawa T, Iwai Y, Sato M, Okamoto H, Kano T, Osano S, Nagano O, Nakazaki K. Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan. J Neurosurg 2016; 124:403-10. [DOI: 10.3171/2015.3.jns142677] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs).
METHODS
This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm3, and the median prescription dose to the tumor margin was 12 Gy.
RESULTS
The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing.
CONCLUSIONS
GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.
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Affiliation(s)
| | - Takenori Kato
- 1Department of Neurosurgery, Komaki City Hospital, Komaki
| | - Yoshihisa Kida
- 2Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya
| | - Motohiro Hayashi
- 3Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo
| | | | - Yoshiyasu Iwai
- 5Department of Neurosurgery, Osaka City General Hospital, Osaka
| | - Mitsuya Sato
- 6Department of Neurosurgery, Kitanihon Neurosurgical Hospital, Gosen
| | | | - Tadashige Kano
- 8Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki
| | - Seiki Osano
- 9Department of Neurosurgery, Shonan Fujisawa Tokushukai Hospital, Fujisawa
| | - Osamu Nagano
- 10Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara; and
| | - Kiyoshi Nakazaki
- 11Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Japan
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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.
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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
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Multisession Gamma Knife Radiosurgery: A Preliminary Experience with a Noninvasive, Relocatable Frame. World Neurosurg 2014; 82:1256-63. [DOI: 10.1016/j.wneu.2014.07.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/02/2014] [Accepted: 07/29/2014] [Indexed: 11/20/2022]
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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.
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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
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Abstract
This article summarizes tumor control and functional outcomes of stereotactic radiosurgery (SRS) for patients with nonvestibular schwannomas, in comparison with those treated with microsurgical resection. To date, surgical resection has been a common treatment for nonvestibular schwannomas. Because these tumors are generally benign, complete tumor resection is a desirable curative treatment. However, it is almost infeasible to completely remove these tumors without any complications, even for experienced neurosurgeons, because of adherence to surrounding critical structures such as cranial nerves, brainstem, or vessels. SRS provides a good tumor control rate with much less morbidity than microsurgical resection.
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Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture 485-8520, Japan.
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Sedney CL, Nonaka Y, Bulsara KR, Fukushima T. Microsurgical Management of Jugular Foramen Schwannomas. Neurosurgery 2012; 72:42-6; discussion 46. [DOI: 10.1227/neu.0b013e3182770e74] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Jugular foramen schwannomas are uncommon and surgically challenging lesions.
OBJECTIVE:
To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas.
METHODS:
A retrospective review and case-control analysis of a single-senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed, focusing on operative technique. Patients undergoing an aggressive, total tumor resection (series 1) were compared with those undergoing more conservative resection focusing on preserving the pars nervosa (series 2).
RESULTS:
There was a statistically significant (P = .04) decrease in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in 3 patients (5.7%) in series 1 and in 3 patients (10.7%) in series 2 (P = .36). Recurrence was treated with reoperation in 1 patient, radiation in 1 patient, and observation in the others.
CONCLUSION:
Although radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a nonstatistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era.
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Affiliation(s)
- Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
| | - Yoichi Nonaka
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Ketan R. Bulsara
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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