Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study

Mehta, Gautam U.; Leković, Gregory P.; Slattery, William H.; Brackmann, Derald E.; Long, Hao; Kano, Hideyuki; Kondziolka, Douglas; Mureb, Monica; Bernstein, Kenneth; Langlois, Ariane; Mathieu, David; Nabeel, Ahmed M; Reda, Wael A.; Tawadros, Sameh R; Abdelkarim, Khaled; El-Shehaby, Amr M N; Emad, Reem M; Mohammed, Nasser; Urgošík, Dušan; Lee, Cheng‐Chia; Yang, Huai Che; Montazeripouragha, Amanallah; Kaufmann, Anthony M.; Joshi, Krishna C.; Barnett, Gene H.; Trifiletti, Daniel M.; Lunsford, L. Dade; Sheehan, Jason P.

doi:10.1093/neuros/nyaa313

Cited by 11 publications

(15 citation statements)

References 22 publications

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“…Studies have suggested that with a treatment goal of preventing the tumor growth while preserving function of facial nerve in FNS, surgery poses a higher risk of facial palsy compared to SRS for facial nerve function [14]. Further, multi-institutional studies have demonstrated that SRS can result in durable tumor control 87.2-92% and facial nerve functional preservation of approximately 90-94% [15][16][17]. No study to date has assessed the relationship of hfSRS to radiological and functional outcome in FNS.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma

Fatima¹,

Dine²,

Barnard³

et al. 2022

Otol Neurotol

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ObjectiveIn the current era of modern neurosurgery, the treatment strategies have been shifted to “nerve-preservation approaches” for achieving a higher facial and hearing function preservation rate following facial nerve tumors. We have conducted this novel report on determining the outcome of patients with facial nerve schwannomas (FNS) treated with hypofractionated stereotactic radiosurgery (hfSRS).PatientsRetrospective chart review of a prospectively maintained database search was conducted.InterventionPatients who underwent hfSRS CyberKnife (Accuray Inc, Sunnyvale, CA, U.S.A.) for FNS were included.Main Outcome MeasuresOutcomes consisted of tumor control, facial and hearing nerve function as graded by House-Brackmann and American Academy of Otolaryngology-Head and Neck Surgery recommendations, and adverse radiation effects.ResultsWith an institutional board review approval, we retrospectively identified five patients with FNS (four intracranial [80%] and one extracranial [20%]) treated with hfSRS (2011–2019). Patients received definitive SRS in three patients (60.0%), whereas adjuvant to surgical resection in two patients (40.0%). A median tumor volume of 7.5 cm3 (range, 1.5–19.6 cm3) received a median prescription dose of 23.2 Gy (range, 21–25 Gy) administered in median of three fractions (range, three to five sessions). With a median radiographic follow-up of 31.4 months (range, 13.0–71.0 mo) and clinical follow-up of 32.6 months (range, 15.1–72.0 mo), the local tumor control was 100.0%. At the last clinical follow-up, the facial nerve function improved or remained unchanged House-Brackmann I–II in 80.0% of the patients, whereas the hearing nerve function improved or remained stable in 100.0% of the patients. Temporary clinical toxicity was observed in three patients (60.0%), which resolved. None of the patients developed adverse radiation effect.ConclusionFrom our case series, hfSRS in FNS seems to be safe and efficacious in terms of local tumor control, and improved facial and hearing nerve function.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma

Fatima¹,

Dine²,

Barnard³

et al. 2022

Otol Neurotol

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“…Facial nerve schwannomas were differentiated from vestibular nerve schwannomas by intraoperative findings or by neurological features and radiologic characteristics. 1,3 Facial nerve schwannoma patients had more facial nerve function deficits along with tumor involvement of the temporal bone or extra temporal segments. 3 All imaging was reviewed by experienced neuroradiologists, as well as radiosurgical teams practicing at tertiary or quaternary referral centers.…”

Section: Patient Populationmentioning

confidence: 97%

“…A different cohort with a distinctly different analytic approach was presented in a prior study. 1 Of the 63 patients included in that study, eight patients managed with decompressive (8/55, 14.5%) surgery and/or multi-session radiosurgery were excluded. In the current study, a retrospective analysis was performed on 55 patients, treated with SRS alone (43 patients) or resection followed by SRS (12 patients), either because of tumor progression or as an adjuvant.…”

Section: Patient Populationmentioning

confidence: 99%

Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol

Dayawansa

Dumot

Mantziaris

et al. 2022

J Neurol Surg B Skull Base

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Background: Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect. Objective: To evaluate outcomes of patients treated with SRS Vs resection+SRS. Method: We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection+SRS. The primary study outcome was unfavorable combined endpoint, defined as worsening or new clinical symptoms, and/or tumor radiological progression. SRS (38.81+ 5.3) and resection+ SRS (67.14+ 11.8) groups had similar clinical follow ups. Results: At the time of SRS, the tumor volumes of SRS (mean+ standard error; 1.83cc+ 0.35CC) and resection+ SRS (2.51cc+ 0.75CC) groups were similar. SRS (12.15+0.08 Gy) and resection+ SRS (12.16+ 0.14 Gy) groups received similar radiation doses. SRS group (42/43, 98%) had better local tumor control than the resection+SRS group (10/12, 83%, p=0.04). Most of SRS (32/43, 74%) and resection+SRS (10/12, 83%) group patients reached a favorable combined endpoint following SRS (P=0.52). Considering surgical associated side effects, only 2/10 patients of resection+SRS group reached a favorable end point (P<0.001). Patients of SRS group, who are >34 years old (p=0.02), have larger tumors (>4cc, 0.04), internal auditory canal (IAC) segment tumor involvement (p=0.01) were more likely to reach an unfavorable endpoint. Resection+SRS group patients did not show such a difference. Conclusions: While resection is still needed for larger tumors, SRS offers better clinical and radiological outcomes compared to resection followed by SRS for facial schwannomas. Younger age, smaller tumors, and non-IAC situated tumors are factors that portend a favorable outcome.

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“…Stereotactic radiosurgery has shown very good control rates (90-100%) for facial nerve schwannoma [27,37,44,54,73]. A recent multicentre retrospective study by Mehta et al [51] studied 63 patients who had SRS for facial nerve schwannomas. At last follow-up, 48% of tumours were stable, 46% had regressed, and 6% had progressed.…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII)

et al. 2022

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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 second of a three-part series describing non-vestibular schwannomas (V, VII). 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 trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.

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Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study

Cited by 11 publications

References 22 publications

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma

Safety and Efficacy of Hypofractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma

Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol

Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII)

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