Stereotactic Radiotherapy for Intracranial Nonacoustic Schwannomas Including Facial Nerve Schwannoma

Nishioka, Kentaro; Abo, Daisuke; Aoyama, Hidefumi; Furuta, Yasushi; Onimaru, Rikiya; Onodera, Shunsuke; Sawamura, Yutaka; Ishikawa, Masayori; Fukuda, Satoshi; Shirato, Hiroki

doi:10.1016/j.ijrobp.2008.12.063

Cited by 61 publications

(34 citation statements)

References 22 publications

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“…Recently, radiotherapy has been advocated as a less invasive alternative primary treatment in patients with FNSs [Mabanta et al, 1999;Kida et al, 2007;Litre et al, 2007;McClelland et al, 2007;Hillman et al, 2008;Madhok et al, 2009;Nishioka et al, 2009, Wilkinson et al, 2011. The efficiency of radiotherapy in long-term tumor control is still unknown, and further studies with longer follow-up are necessary [Marzo et al, 2009].…”

Section: Discussionmentioning

confidence: 99%

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Bacciu

Nusier²,

Lauda³

et al. 2013

Audiol Neurotol

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Objectives: To describe the decision-making strategies for complex facial nerve schwannomas (FNSs). Materials and Methods: Charts belonging to 103 consecutive patients with facial nerve tumors managed between 1990 and 2011 were examined retrospectively to identify complex FNSs. To be classified as complex, at least one of the following criteria had to be met: (1) FNS with large intraparotid tumor component and preoperative good facial nerve function (3 cases); (2) multiple-segment FNSs with extension to both the cerebellopontine angle and the middle cranial fossa in patients with preoperative good hearing (5 cases); (3) fast-growing FNS with preoperative good facial nerve function (4 cases), and (4) large FNS compressing the temporal lobe with preoperative normal facial nerve function (1 case). Results: Thirteen patients were classified as complex; 12 patients had total tumor removal with sural nerve grafting and 1 patient had partial tumor removal.Two patients with intratemporal-intraparotid FNS underwent a transmastoid-transparotid approach. One patient with a tumor extending from the geniculate ganglion to the parotid portion of the facial nerve underwent a combined middle fossa transmastoid-transparotid approach.A transcochlear approach with temporal craniotomy was performed in all the patients with multiple-segment FNS as well as in patients with fast-growing tumors extending both in the cerebellopontine angle and middle cranial fossa. A partial tumor removal through the middle fossa approach was performed in 1 patient with a large tumor compressing the temporal lobe. Conclusions: Therapeutic options for patients with FNS include surgical intervention, observation and radiotherapy. Nowadays, surgical resection with facial nerve repair is usually the standard management for patients with poor facial function (House-Brackmann grade III or worse). In patients presenting with normal or near-normal facial nerve function, initial observation with periodic examination and imaging is usually recommended. However, on rare occasions surgeons can be faced with a situation in which the management decision-making process is particularly challenging. In these complex cases treatment should be individualized. We recommend early surgical intervention regardless of the preoperative facial and hearing functions in the following cases: intratemporal FNSs extending with a large tumor component into the parotid, multiple-segment FNSs extending in both the cerebellopontine angle and the middle cranial fossa, fast-growing FNSs, and large FNSs with temporal lobe compression.

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Section: Discussionmentioning

confidence: 99%

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Bacciu

Nusier²,

Lauda³

et al. 2013

Audiol Neurotol

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“…Osteomalacia is characterized by defective mineralization of osteoid and vit D deficiency is one of the causes of osteomalacia in the adult population [5]. It can be asymptomatic, but can also present with aching bones, muscle weakness, pelvic deformities and a waddling gait [6, 7].…”

Section: Discussionmentioning

confidence: 99%

“…The most useful findings alerting physicians to search for a preosteomalacic state are increased serum ALP and PTH levels, reduced urinary calcium excretion and low serum 25-OH vit D levels [5]. …”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency in the Absence of Enteropathy in Three Cases with Common Variable Immunodeficiency

Ardeniz¹,

Avcı²,

Sin³

et al. 2008

Int Arch Allergy Immunol

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Background: Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and a defect in antibody production. Herein we describe 3 patients diagnosed with CVID in whom vitamin D deficiency was detected in the absence of enteropathy. Methods: Biochemical and immunological analysis, serum osteocalcin, parathyroid hormone, 25-OH vitamin D, 1,25(OH)₂ vitamin D, vitamin A, vitamin E, urinary calcium, and deoxypyridinoline measurements were carried out. Vitamin D receptor (VDR) expression was examined in the peripheral blood mononuclear cells and hair follicles by reverse transcriptase polymerase chain reaction. VDR gene polymorphism was evaluated by high-performance liquid chromatography. Results: None of the patients presented nutrient deficiencies other than vitamin D. Two of them were free of osteomalacia-related symptoms. VDR expression was found to be lower in the peripheral blood mononuclear cells and hair follicles when compared to the control group. Conclusions: Patients with CVID may present asymptomatic vitamin D deficiency. Vitamin D and VDRs play an important role in the innate immune system and modulate Toll-like receptor-related responses. Delay in diagnosis may predispose these patients not only to irreparable bone loss but also to infections, and autoimmune and malignant disorders, thus emphasizing the importance of prompt intervention.

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“…When the tumor size is too large to be treated by a single session of radiosurgery, stereotactic radiotherapy may be an acceptable treatment option. 26,29,31 …”

Section: Treatment Strategymentioning

confidence: 99%

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

Hasegawa

Kato

Kida

et al. 2016

JNS

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obJective 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 cm 3 , 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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Stereotactic Radiotherapy for Intracranial Nonacoustic Schwannomas Including Facial Nerve Schwannoma

Cited by 61 publications

References 22 publications

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Vitamin D Deficiency in the Absence of Enteropathy in Three Cases with Common Variable Immunodeficiency

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

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