Gamma Knife surgery and trigeminal schwannoma: is it possible to preserve cranial nerve function?

Phi, Ji Hoon; Paek, Sun Ha; Chung, Hyun-Tai; Jeong, Sang Soon; Park, Shin Young; Jung, Hee-Won; Kim, Dong Gyu

doi:10.3171/jns-07/10/0727

Cited by 39 publications

(23 citation statements)

References 26 publications

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“…29,30 However, cranial nerve damage can develop during the period of transient tumor expansion in some patients. 28,29 Because the cochlear nerves of NF2 patients appear to be quite vulnerable to injury, close follow-up with serial MRI and audiometry and timely intervention are required after radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

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Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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BACKGROUND:The radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) is controversial. The authors investigated the radiologically proven tumor control rate after gamma knife radiosurgery. The factors that affect tumor control and serviceable hearing preservation were analyzed.METHODS:Thirty‐six lesions in 30 patients were included. The median lengths of the clinical and radiologic follow‐ups were 48.5 months and 36.5 months, respectively. The median tumor volume was 3.2 cm3. The mean marginal dose was 12.1 grays (Gy) (range, 8–14 Gy) at an isodose line of 50%±0.6%. The Kaplan‐Meier method and Cox proportional hazards model were used for the statistical analyses.RESULTS:The actuarial tumor control rate was 81%, 74%, and 66%, respectively, in the first, second, and fifth years. Five tumors required a salvage surgery because of tumor control failure. A low marginal dose and a young age at radiosurgery were associated with poor tumor control. Of the 16 tumors with which ipsilateral hearing was serviceable, the actuarial serviceable hearing preservation rates were 50%, 45%, and 33%, respectively, in the first, second, and fifth years. Better ipsilateral hearing (Gardner‐Robertson grade 1, compared with grade 2) at the time of radiosurgery was associated with significantly greater serviceable hearing preservation.CONCLUSIONS:Gamma knife radiosurgery for vestibular schwannomas in NF2 patients provided 5‐year tumor control in approximately two‐thirds of patients and preserved serviceable hearing in approximately one‐third. The rates of other cranial nerve deficits were low, and no secondary malignancy was observed. Radiosurgery should be included in treatment options for NF2 patients. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

“…Transient tumor expansion with loss of contrast enhancement is a common finding after radiosurgery and is frequently followed by tumor shrinkage. [28][29][30][31] Therefore, it is regarded as evidence of radiosurgical effect. 29,30 However, cranial nerve damage can develop during the period of transient tumor expansion in some patients.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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“…For small, nonresectable and residual tumors, good results have been reported with radiosurgery (17,18). Long-term follow-up of patients treated with this method is still needed to evaluate the exact role of the radiosurgery in the late control of these lesions (17,18).…”

Section: Discussionmentioning

confidence: 99%

“…Several contemporary series have demonstrated no deaths or major surgical complications with radical removal of tumors in the Meckel's cave and gasserian ganglion (6,21). For small, nonresectable and residual tumors, good results have been reported with radiosurgery (17,18). Long-term follow-up of patients treated with this method is still needed to evaluate the exact role of the radiosurgery in the late control of these lesions (17,18).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of rare metastatic tumor in Meckel’s Cave: a case report

Rădoi¹,

Stefanescu²,

Vakilnejad³

et al. 2017

Romanian Neurosurgery

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Abstract:Objectives: Metastases in Meckel's cave are a rare tumor entity, but they should be considered in patients with a known primary malignancy and who complain of trigeminal neuralgia. Methods: The case of a patient with a left trigeminal neuralgia caused by a metastatic tumor involving the Meckel's cave and Gasserian ganglion is reported. Preoperative symptoms included headache, trigeminal hyperesthesia and facial pain. Results: The patient underwent microsurgical resection of the tumor, obtaining a histological diagnosis and a resolution of the pain. Trigeminal motor function was preserved. Conclusion: The best treatment for tumors of Meckel's cave, including metastases, is complete microsurgical removal. Although good results have been reported with radiosurgery, this treatment should be reserved only for nonresectable and residual tumors.

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“…Tumors of the cavernous sinus except for schwannomas tend to be treated by surgical resection rather than stereotactic radiosurgery due to concerns regarding removal, hemostasis, and the appearance of new postoperative deficits. Gamma-knife surgery for trigeminal schwannoma provides a high rate of tumor control and functional improvement, 13) and surgical treatment leads to good outcomes. 3) Therefore, surgical intervention is appropriate for schwannoma extending into the cavernous sinus.…”

Section: Introductionmentioning

confidence: 99%

Orbital Schwannoma Extending to the Lateral Wall of the Cavernous Sinus Through the Superior Orbital Fissure -Case Report-

Hironaka

Nakase

Motoyama

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 58-year-old man presented with a rare orbitocavernous sinus schwannoma that originated from the orbital opthalmic nerve, and manifested as slowly progressive hypesthesia of the right side of the forehead, proptosis, and ocular pain with rapidly worsening visual acuity. Magnetic resonance imaging revealed a huge orbital tumor extending to the lateral wall of the cavernous sinus through the superior orbital fissure. Microsurgical total resection of the tumor was achieved using an epidural orbitofrontal approach with orbito-fronto-zygomatic craniotomy. The histological diagnosis was schwannoma with Antoni type A formation. The postoperative course was uneventful except for the hypesthesia on the right side of the forehead and transient oculomotor paralysis. Surgery was effective to relieve the symptoms and improve the activities of daily living.

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Gamma Knife surgery and trigeminal schwannoma: is it possible to preserve cranial nerve function?

Cited by 39 publications

References 26 publications

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Surgical treatment of rare metastatic tumor in Meckel’s Cave: a case report

Orbital Schwannoma Extending to the Lateral Wall of the Cavernous Sinus Through the Superior Orbital Fissure -Case Report-

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