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Troude L, Ogando YE, Balossier A, Baucher G, Régis J, Roche PH. Surgical management of large lower cranial nerves schwannomas: long term results of a less aggressive resection strategy. Neurosurg Rev 2024; 47:171. [PMID: 38639892 DOI: 10.1007/s10143-024-02416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
In an effort to reduce the high morbidity and life-threatening complications after radical resection in large schwannoma surgery, alternative strategies of nontotal resections have emerged. To evaluate the long term clinical and oncological outcome after lower cranial nerves (LCN) schwannoma surgery operated on with a cranial nerve-sparing technique. Single center retrospective cohort study of 8 consecutive patients harboring LCN schwannomas operated on between March 2005 and October 2021. The mean LCN schwannoma diameter was 33 mm (range 26-51). Seven patients (87,5%) underwent a modified retrosigmoid approach. Three patients underwent gross total resection (37,5%), 3 had received neartotal resection (mean tumor residue 0,25 cc) and subtotal resection in 2 patients who presented with an extracranial extension of the tumor (mean tumor residue 2,44 cc). Both patients had received upfront additional GKRS. The three patients who presented with preoperative CN IX & X injuries recovered within 6 months after surgery. All of the five patients freed from any preoperative CNs IX & X symptoms experienced transient (80%) or definitive (one patient) disturbances after surgery. They all improved within 6 months but one who required long term gastrostomy feeding tube. This patient harbored a schwannoma originating from the glossopharyngeal nerve, which could not be anatomically preserved during surgery. Tumor control was achieved in 100% of cases with a mean follow-up of 91 months. LCN schwannomas could be surgically removed through a less aggressive non-radical resection strategy with acceptable functional results and excellent tumor control.
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Affiliation(s)
- Lucas Troude
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France.
| | - Yamaurys Esther Ogando
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
| | - Anne Balossier
- Department of Neurosurgery, Timone University Hospital, APHM-AMU - 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Guillaume Baucher
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
| | - Jean Régis
- Department of Neurosurgery, Timone University Hospital, APHM-AMU - 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Pierre-Hugues Roche
- Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France
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Carlstrom LP, Bauman MMJ, Oushy S, Perry A, Brown PD, Peris-Celda M, Van Gompel JJ, Graffeo CS, Link MJ. Lower Cranial Nerve Schwannomas: Cohort Study and Systematic Review. Neurosurgery 2024; 94:745-755. [PMID: 37874134 DOI: 10.1227/neu.0000000000002735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Schwannomas originating from the lower cranial nerves (LCNS) are rare and pose a significant surgical challenge. Resection is the mainstay treatment; however, risk of treatment morbidity is considerable, and the available literature regarding differential treatment outcomes in this vulnerable population is sparse. METHODS A single-institution cohort study and systematic literature review of LCNS were performed. RESULTS Fifty-eight patients were included: 34 underwent surgical resection and 24 underwent stereotactic radiosurgery (SRS). The median age at diagnosis was 48 years (range 17-74). Presenting symptoms were dysphagia (63%), dysarthria/hypophonia (47%), imbalance (33%), and hearing loss/tinnitus (30%). Tumor size was associated with surgical resection, as compared with initial SRS (4.1 cm vs 1.5 cm, P = .0001). Gross total resection was obtained in 52%, with tumor remnants predominantly localized to the jugular foramen (62%). Post-treatment worsening of symptoms occurred in 68% of surgical and 29% of SRS patients ( P = .003). Postoperative symptoms were mostly commonly hypophonia/hoarseness (63%) and dysphagia (59%). Seven patients (29%) had new neurological issues after SRS treatment, but symptoms were overall milder. The median follow-up was 60 months (range 12-252); 98% demonstrated meaningful clinical improvement. Eighteen surgical patients (53%) underwent adjuvant radiation at a median of 5 months after resection (range 2-32). At follow-up, tumor control was 97% in the surgical cohort and 96% among SRS patients. CONCLUSION Although LCNS resection is potentially morbid, most postoperative deficits are transient, and patients achieve excellent tumor control-particularly when paired with adjuvant SRS. For minimally symptomatic patients undergoing surgical intervention, we advise maximally safe resection with intracapsular dissection to preserve nerve integrity where possible. For residual or as a primary treatment modality, SRS is associated with low morbidity and high rates of long-term tumor control.
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Affiliation(s)
- Lucas P Carlstrom
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
| | - Megan M J Bauman
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
| | - Soliman Oushy
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
| | - Avital Perry
- Department of Neurosurgery, Sheba Medical Center, Tel Aviv , Israel
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester , Minnesota , USA
| | - Maria Peris-Celda
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
- Department of Otolaryngology, Mayo Clinic, Rochester , Minnesota , USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
- Department of Otolaryngology, Mayo Clinic, Rochester , Minnesota , USA
| | | | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
- Department of Otolaryngology, Mayo Clinic, Rochester , Minnesota , USA
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Spiegelberg M, Ermiş E, Raabe A, Tarnutzer AA. Triggered episodic vestibular syndrome and transient loss of consciousness due to a retrostyloidal vagal schwannoma: a case report. Front Neurol 2023; 14:1222697. [PMID: 37435156 PMCID: PMC10330762 DOI: 10.3389/fneur.2023.1222697] [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: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Background Various conditions may trigger episodic vertigo or dizziness, with positional changes being the most frequently identified condition. In this study, we describe a rare case of triggered episodic vestibular syndrome (EVS) accompanied by transient loss of consciousness (TLOC) linked to retrostyloidal vagal schwannoma. Case description A 27-year woman with known vestibular migraine presented with a 19-month history of nausea, dysphagia, and odynophagia triggered by swallowing food and followed by recurrent TLOC. These symptoms occurred independently of her body position, resulting in a weight loss of 10 kg within 1 year and in an inability to work. An extensive cardiologic diagnostic work-up undertaken before she presented to the neurologic department was normal. On the fiberoptic endoscopic evaluation of swallowing, she showed a decreased sensitivity, a slight bulging of the right lateral pharyngeal wall, and a pathological pharyngeal squeeze maneuver without any further functional deficits. Quantitative vestibular testing revealed an intact peripheral-vestibular function, and electroencephalography was read as normal. On the brain MRI, a 16 x 15 x 12 mm lesion in the right retrostyloidal space suspicious of a vagal schwannoma was detected. Radiosurgery was preferred over surgical resection, as resection of tumors in the retrostyloid space bears the risk of intraoperative complications and may result in significant morbidity. A single radiosurgical procedure (stereotactic CyberKnife radiosurgery, 1 x 13Gy) accompanied by oral steroids was performed. On follow-up, a cessation of (pre)syncopes was noted 6 months after treatment. Only residual infrequent episodes of mild nausea were triggered by swallowing solid food remained. Brain MRI after 6 months demonstrated no progression of the lesion. In contrast, migraine headaches associated with dizziness remained frequent. Discussion Distinguishing triggered and spontaneous EVS is important, and identifying specific triggers by structured history-taking is essential. Episodes being elicited by swallowing solid foods and accompanied by (near) TLOC should initiate a thorough search for vagal schwannoma, as symptoms are often disabling, and targeted treatment is available. In the case presented here, cessation of (pre)syncopes and significant reduction of nausea triggered by swallowing was noted with a 6-month delay, illustrating the advantages (no surgical complications) and disadvantages (delayed treatment response) of first-line radiotherapy in vagal schwannoma treatment.
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Affiliation(s)
| | - Ekin Ermiş
- Department of Radiation Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Neurosurgery, Bern University Hospital, Bern, Switzerland
| | - Alexander Andrea Tarnutzer
- Neurology, Cantonal Hospital of Baden, Baden, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Palmisciano P, Ferini G, Watanabe G, Conching A, Ogasawara C, Scalia G, Bin-Alamer O, Haider AS, Passanisi M, Maugeri R, Hoz SS, Baldoncini M, Campero A, Salvati M, Cohen-Gadol AA, Umana GE. Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review. Curr Oncol 2022; 29:4842-4855. [PMID: 35877244 PMCID: PMC9319499 DOI: 10.3390/curroncol29070384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Gina Watanabe
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy;
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maurizio Passanisi
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Experimental Biomedicine & Clinical Neuroscience, Azienda Ospedaliera Universitaria Policlinico, 90127 Palermo, Italy;
| | - Samer S. Hoz
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina;
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Maurizio Salvati
- Department of Neurosurgery, Neuromed, IRCCS, Sapienza University of Rome, 86077 Pozzilli, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Giuseppe E. Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
- Correspondence: ; Tel.: +39-38-0332-5479
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Chew CH, Chen JC, Hung SK, Wu TH, Lee MS, Chiou WY, Chen LC, Lin HY. Clinical outcomes of benign brain tumors treated with single fraction LINAC-based stereotactic radiosurgery: Experience of a single institute. Tzu Chi Med J 2022; 34:462-472. [PMID: 36578643 PMCID: PMC9791860 DOI: 10.4103/tcmj.tcmj_260_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/25/2021] [Accepted: 01/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives Accelerator-based stereotactic radiosurgery (SRS) is a noninvasive and effective treatment modality widely used for benign brain tumors. This study aims to report 20-year treatment outcomes in our institute. Materials and Methods From May 2001 to December 2020, 127 patients treated with LINAC-based single-fraction SRS for their benign brain lesions were included. A neurosurgeon and two radiation oncologists retrospectively reviewed all data. Computed tomography (CT) simulation was performed after head-frame fixation under local anesthesia. All planning CT images were co-registered and fused with gadolinium-enhanced magnetic resonance imaging taken within 3 months for lesions targeting and critical organs delineation. The marginal dose was prescribed at 60%-90% isodose lines, respectively, to cover ≥95% planning target volume. Outcome evaluations included clinical tumor control rate (TCR), defined as the need for salvage therapy, and radiological response, defined as no enlargement of >2 cm in the maximal diameter. Overall survival (OS) and adverse reaction (defined according to CTCAE 5.0) were also analyzed. Results The present study included 76 female and 51 male patients for analysis. The median age was 59 years (range, 20-88 years). Their diagnoses were vestibular schwannoma (VS, n = 54), nonvestibular cranial nerve schwannoma (n = 6), meningioma (n = 50), and pituitary adenoma (n = 17). Totally 136 lesions were treated in a single fraction, predominantly skull base tumors, accounting for 69.1%. Median and mean follow-up duration was 49 and 61 months (range, 1-214 months), Overall TCR was 92.9%. The 5-year disease-specific TCR for VS, nonvestibular schwannoma, meningioma, and pituitary adenoma were 97.4%, 91.7%, 93.8%, and 83.3%. Salvage therapy was indicated for eight patients at 4-110 months after SRS. Among symptomatic patients, post-SRS symptom(s) was improved, stable, and worse in 68.2%, 24.3%, and 3.6%, respectively. Radiological response rate for 111 evaluable patients was 94.6% (shrinkage, 28.8%; stable, 65.8%). OS was 96.1% without treatment-related mortality. One patient with post-SRS cranial nerve injury (0.8%, involving the trigeminal nerve, grade 2 toxicities). No grade 3-4 acute or late toxicity was found. Conclusion Our results suggested that LINAC-based SRS effectively controls tumor growth and tumor-related neurological symptoms for patients with benign brain tumors. SRS is less aggressive, associated with low neurological morbidity and no mortality. Continuous follow-up is indicated to conclude longer outcomes.
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Affiliation(s)
- Chia-Hui Chew
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jin-Cherng Chen
- Department of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tsung-Hsien Wu
- Department of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan,Institute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan,Address for correspondence: Dr. Hon-Yi Lin, Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan. E-mail:
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Early-onset adverse events after stereotactic radiosurgery for jugular foramen schwannoma: a mid-term follow-up single-center review of 46 cases. Radiat Oncol 2022; 17:89. [PMID: 35525985 PMCID: PMC9077941 DOI: 10.1186/s13014-022-02057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recently, stereotacitc radiosurgery (SRS) has been in the spotlight as an alternative therapeutic option for jugular foramen schwannomas (JFS). While most reported studies focus on the long-term efficacy and safety issues of SRS, none describe the early-onset adverse events (eAEs). We aimed to investigate the incidence, clinical characteristics, and mid-term outcomes of eAEs occurring within six months after SRS for JFS. Methods In this retrospective review, patients who underwent at least six months of follow-up were included among all patients with JFS who have performed SRS at our institution between July 2008 and November 2019. And eAEs were defined as a newly developed neurological deficit or aggravation of pre-existing symptoms during the first six months after SRS. Results Forty-six patients were included in the analysis. The median follow-up period was 50 months (range 9–136). The overall tumor control rate was 91.3%, and the actuarial 3-, 5-, and 10-year progression-free survival rates were 97.8%, 93.8%, and 76.9%, respectively. Of the 46 patients, 16 had eAEs, and the median time to onset of eAEs was one month (range 1–6 months), and the predominant symptoms were lower cranial nerve dysfunctions. Thirteen of 16 patients showed improved eAE symptoms during the follow-up period, and the median resolution time was six months (range 1–52). In 11 (68.8%) of 16 patients with eAEs, transient expansions were observed with a mean of 3.6 months after the onset of eAEs, and the mean difference between the initial tumor volume and the transient expansion volume was more prominent in the patients with eAEs (3.2 cm3 vs. 1.0 cm3; p = 0.057). In univariate analysis, dumbbell-shaped tumors (OR 10.56; p = 0.004) and initial tumor volume (OR 1.32; p = 0.033) were significantly associated with the occurrence of eAEs. Conclusions Although acute adverse events after SRS for JFS are not rare, these acute effects were not permanent and mostly improved with the steroid treatment. Dumbell-shaped and large-volume tumors are significant predictive factors for the occurrence of eAEs. And the transient expansion also seems to be closely related to eAEs. Therefore, clinicians need to be more cautious when treating these patients and closely monitor the occurrence of eAEs.
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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 H, 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 III: Lower cranial nerve schwannomas, jugular foramen (CN IX, X, XI) and hypoglossal schwannoma (XII). Acta Neurochir (Wien) 2022; 164:321-329. [PMID: 34854994 DOI: 10.1007/s00701-021-05072-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: 11/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous 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 committee 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 third of a three-part series describing non-vestibular schwannomas (IX, X, XI, XII). 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 preoperative 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 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
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Henry 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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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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Wang X, Liang J, Li M, Bai J, Tang J, Bao Y, Xiao X. Surgical treatment of dumbbell-shaped jugular foramen schwannomas via two-piece lateral suboccipital approach: Report of 26 patients. J Clin Neurosci 2021; 94:32-37. [PMID: 34863457 DOI: 10.1016/j.jocn.2021.08.011] [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: 03/02/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dumbbell-shaped jugular foramen schwannomas (JFS) are rare but challenging for the treatment. Surgical resection is believed to be the optimal therapy; however, postoperative dysfunction of the lower cranial nerves (CNs), tumor residual, cerebrospinal fluid (CSF) leakage, and subcutaneous hydrops are common. The current study's objectives were to describe the optimal surgical strategies for the total removal of dumbbell-shaped JFS, the functional preservation of lower CNs, and the prevention of postoperative CSF leakage. METHODS 26 consecutive patients with dumbbell-shaped JFS were surgically treated between January 2014 and June 2019. All patients were operated on via two-piece lateral suboccipital approach, vascularized muscle flap was used for the repair of the dural defect after an operation. The clinical information and radiological data of these patients were retrospectively reviewed, and the optimal surgical strategies were further evaluated and discussed. RESULTS The tumor was completely removed in all 26 patients, one patient developed new CN Ⅶ paralysis, and 2 developed new CN IX and Ⅹ paralysis after an operation, all patients were significantly relieved during follow up. None of them developed subcutaneous hydrops and postoperative CSF leakage. No tumor recurrence was observed during a mean follow up of 38.8 (16-69) months. CONCLUSIONS Dumbbell-shaped JFS could be safely and completely removed via the two-piece lateral suboccipital approach. Postoperative CSF leakage could be effectively prevented by careful repair of the dural defect in the jugular foramen (JF) and filling the mastoid cavity with a vascularized muscular flap.
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Affiliation(s)
- Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China.
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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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11
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Long-Term Outcomes of Stereotactic Radiosurgery for Trigeminal, Facial, and Jugular Foramen Schwannoma in Comparison with Vestibular Schwannoma. Cancers (Basel) 2021; 13:cancers13051140. [PMID: 33799972 PMCID: PMC7961475 DOI: 10.3390/cancers13051140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Intracranial schwannomas are benign intracranial neoplasms. Vestibular schwannomas (VS) account for 90% of intracranial schwannomas; whereas the other cranial nerve schwannomas, such as trigeminal (TS), facial (FS), and jugular foramen schwannoma (JFS), account for 10% of all cases. Stereotactic radiosurgery (SRS) is a minimally invasive treatment for small to medium VS and known to provide excellent long-term tumor control; however, there remains a paucity of evidence regarding SRS for TS, FS, and JFS due to the rarity of these tumors. We investigated the radiosurgical outcomes of these non-vestibular schwannomas and compared them to those of VS through matched cohort analysis. Abstract Stereotactic radiosurgery (SRS) is known to provide excellent tumor control with functional preservation for vestibular schwannomas (VS), but its efficacy in the other major intracranial schwannomas including trigeminal (TS), facial (FS), and jugular foramen schwannomas (JFS) has not been established yet due to their rarity. We retrospectively analyzed data of 514 consecutive patients who had intracranial schwannomas (460 VS, 22 TS, 7 FS, and 25 JFS) and underwent SRS. The 5- and 10-year tumor control rates were 97% and 94% for VS, 100% and 100% for TS, 80% and 80% for FS, and 100% and 80% for JFS. Radiation-induced complications included one hydrocephalus for TS (4.5%), no cases for FS (0%), and one hydrocephalus and one lower palsy for JFS (8.0%). Through matched cohort analysis between patients with VS and each of the non-VS, we found no statistical difference in tumor control and radiation-induced adverse events. SRS seems to provide long-term tumor control with functional preservation for TS, FS and JFS and the efficacies are similar to VS.
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12
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Suárez C, López F, Mendenhall WM, Andreasen S, Mikkelsen LH, Langendijk JA, Bondi S, Rodrigo JP, Bäck L, Mäkitie AA, Fernández-Alvarez V, Coca-Pelaz A, Smee R, Rinaldo A, Ferlito A. Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas. Cancer Manag Res 2021; 13:463-478. [PMID: 33500660 PMCID: PMC7822088 DOI: 10.2147/cmar.s287410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/30/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5–10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stefano Bondi
- Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | | | - Andrés Coca-Pelaz
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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13
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Kiyofuji S, Shin M, Kondo K, Koike T, Kin T, Saito N. Endoscopic transnasal resection of the CP angle schwannoma. NEUROSURGICAL FOCUS: VIDEO 2020; 2:V13. [PMID: 36284780 PMCID: PMC9542688 DOI: 10.3171/2020.4.focusvid.19891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 11/06/2022]
Abstract
Cerebellopontine (CP) angle tumors are often resected via retrosigmoid craniotomy; however, sometimes cranial nerves (CNs) make their resection more complex. In such cases, the endoscopic transnasal approach can avoid such manipulations as delivering surgical instruments over CNs or peeling off CNs from the tumor, minimizing the risk of postoperative deficits. A 35-year-old man presented with a 37-mm cystic tumor in the right CP angle, and preoperative 3D fusion images revealed that multiple CNs (VII, VIII, and lower CNs) were running on the tumor posteriorly. The endoscopic transnasal approach enabled safe subtotal resection without causing neurological deficits, and the patient underwent stereotactic radiosurgery for the residual schwannoma.The video can be found here: https://youtu.be/xKLwdDsLpWA.
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14
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Wang X, Long W, Liu D, Yuan J, Xiao Q, Liu Q. Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review. Neurosurg Rev 2019; 43:1339-1350. [PMID: 31473876 DOI: 10.1007/s10143-019-01165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 11/29/2022]
Abstract
Complete resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve complications remains difficult even for skilled neurosurgeons. Between November 2011 and November 2017, 31 consecutive patients diagnosed with JFSs underwent a single-stage operation performed by the same neurosurgeon. We retrospectively analyzed clinical characteristics, surgical approaches, treatment outcomes, and follow-up data for these patients. JFSs were classified according to the Samii classification system. A retrosigmoid approach was used to resect type A tumors, while a suboccipital transjugular process (STJP) approach was used to resect type B tumors. Notably, the present study is the first to report the use of a paracondylar-lateral cervical (PCLC) approach for the treatment of type C and D tumors. Type A-D tumors were observed in seven, four, four, and 16 patients, respectively. Gross-total resection was achieved in 29 patients (93.5%). There were no cases of intracranial hematoma, re-operation, tracheotomy, or death. Adjunctive gamma knife treatment was used to manage residual tumors in two patients. Neurological deficits relieved in half of patients at the last follow-up. By reviewing the studies published on PubMed, the approaches gradually be more conservative, rather than widely expose the skull base. Nonetheless, endoscope and stereotactic radiosurgery plays an important role in the management of JFSs. Both tumor removal and neurological function retention can be obtained by choosing individual treatment.
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Affiliation(s)
- Xiangyu Wang
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Wenyong Long
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Jian Yuan
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Qun Xiao
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Qing Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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15
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Kano H, Meola A, Yang HC, Guo WY, Martínez-Alvarez R, Martínez-Moreno N, Urgosik D, Liscak R, Cohen-Inbar O, Sheehan J, Lee JYK, Abbassy M, Barnett GH, Mathieu D, Kondziolka D, Lunsford LD. Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study. J Neurosurg 2018; 129:928-936. [DOI: 10.3171/2017.5.jns162894] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEFor some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.METHODSNine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5–144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8–22.6 cm3), and the median margin dose was 12.5 Gy (range 10–18 Gy). Patients with neurofibromatosis were excluded from this study.RESULTSThe median follow-up was 51 months (range 6–266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non–dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5–38 months). Six patients underwent repeat SRS at a median of 64 months (range 44–134 months). Four patients underwent resection at a median of 14 months after SRS (range 8–30 months).CONCLUSIONSStereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.
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Affiliation(s)
- Hideyuki Kano
- 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania
| | - Antonio Meola
- 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania
| | - Huai-che Yang
- 2Departments of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- 2Departments of Radiation Oncology and Neurological Surgery, Taipei Veterans Hospital, Taipei, Taiwan
| | | | | | - Dusan Urgosik
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Or Cohen-Inbar
- 5Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason Sheehan
- 5Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - John Y. K. Lee
- 6Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mahmoud Abbassy
- 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Gene H. Barnett
- 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Mathieu
- 8Université de Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada; and
| | | | - L. Dade Lunsford
- 1Department of Neurological Surgery, Center for Image-guided Neurosurgery, University of Pittsburgh, Pennsylvania
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16
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Choi Y, Kim S, Kwak DW, Lee HS, Kang MK, Lee DK, Hur WJ. Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy. Radiat Oncol J 2018; 36:114-121. [PMID: 29983031 PMCID: PMC6074071 DOI: 10.3857/roj.2018.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To explore the feasibility of maximum diameter as a response assessment method for vestibular schwannomas (VS) after stereotactic radiosurgery or fractionated stereotactic radiotherapy (RT), we analyzed the concordance of RT responses between maximum diameters and volumetric measurements. Materials and Methods Forty-two patients receiving curative stereotactic radiosurgery or fractionated stereotactic RT for VS were analyzed retrospectively. Twelve patients were excluded: 4 did not receive follow-up magnetic resonance imaging (MRI) scans and 8 had initial MRI scans with a slice thickness >3 mm. The maximum diameter, tumor volume (TV), and enhanced tumor volume (ETV) were measured in each MRI study. The percent change after RT was evaluated according to the measurement methods and their concordances were calculated with the Pearson correlation. The response classifications were determined by the assessment modalities, and their agreement was analyzed with Cohen kappa statistics. Results Median follow-up was 31.0 months (range, 3.5 to 86.5 months), and 90 follow-up MRI studies were analyzed. The percent change of maximum diameter correlated strongly with TV and ETV (r(p) = 0.85, 0.63, p = 0.000, respectively). Concordance of responses between the Response Evaluation Criteria in Solid Tumors (RECIST) using the maximum diameters and either TV or ETV were moderate (kappa = 0.58; 95% confidence interval, 0.32-0.85) or fair (kappa = 0.32; 95% confidence interval, 0.05-0.59), respectively. Conclusion The percent changes in maximum diameter and the responses in RECIST were significantly concordant with those in the volumetric measurements. Therefore, the maximum diameters can be used for the response evaluation of VS following stereotactic RT.
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Affiliation(s)
- Youngmin Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Sungmin Kim
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Won Kwak
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Hyung-Sik Lee
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Myung-Koo Kang
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Kun Lee
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Won-Joo Hur
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
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17
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Ruangkanchanasetr R, Lee JYK, Nagda SN, Geiger GA, Kolker JD, Bigelow DC, Ruckenstein MJ, Nasrallah M, Alonso-Basanta M. Toxicity of Gamma Knife Radiosurgery May Be Greater in Patients with Lower Cranial Nerve Schwannomas. J Neurol Surg B Skull Base 2018; 79:580-585. [PMID: 30456028 DOI: 10.1055/s-0038-1651504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/08/2018] [Indexed: 10/16/2022] Open
Abstract
Objective Gamma Knife stereotactic radiosurgery (GK-SRS) is a preferred treatment option for tumors of the jugular foramen. We hypothesized that GK-SRS toxicity is higher for lower cranial nerve schwannomas than for glomus jugulare tumors despite anatomically similar locations. Methods We performed a retrospective review of all patients who received GK-SRS for glomus jugulare tumors and lower cranial nerve schwannomas at our institution between 2006 and 2014. Because of small sample sizes, Fisher's exact tests and logistic regression techniques were employed using SPSS. Result We identified 20 glomus jugulare tumors and 6 lower cranial nerve schwannoma patients with a median follow-up of 17 months. Median marginal dose was 16 Gy (range 13-18 Gy) and 12.5 Gy (range 12-14 Gy), respectively. All except one patient had tumor control at last follow-up visit. No worsening of pre-existing neurological deficits was observed. There were seven patients who developed any new neurological deficit after GK-SRS, four from the glomus group, and three from the schwannoma group (20 and 50% of each group, respectively). Only two of seven patients had permanent new neurological deficits. Both of them were in the schwannoma group. Univariate analysis showed that only a diagnosis of schwannoma had a greater risk of permanent new cranial nerve complication after GK-SRS compared with diagnosis of glomus jugulare ( p = 0.046). Conclusion Although the marginal dose for glomus jugulare is greater, our study suggests that the risk of a new permanent neurological deficit after GK-SRS was higher in the schwannoma group compared with the glomus group.
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Affiliation(s)
- Rawee Ruangkanchanasetr
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Suneel N Nagda
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Geoffrey A Geiger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James D Kolker
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Douglas C Bigelow
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michael J Ruckenstein
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - MacLean Nasrallah
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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18
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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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