Stereotactic Radiotherapy for the Treatment of Nonacoustic Schwannomas

Hamm, Klaus; Groß, Markus W.; Fahrig, Antje; Surber, Gunnar; Henzel, Martin; Kleinert, Gabriele; Grabenbauer, Gerhard G.; Engenhart‐Cabillic, Rita

doi:10.1227/01.neu.0000325934.16229.03

Cited by 30 publications

(13 citation statements)

References 30 publications

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“…Longterm followup of patients treated with this method is still needed to evaluate the exact role of radiosurgery in the late control of these lesions. 1,[17][18][19]31,35,36,37,44 It is evi dent, however, that no patient will ever be cured of this benign tumor with radiotherapy or radiosurgery. Several contemporary series have demonstrated no deaths or major surgical complications with radical re moval of TSs.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of trigeminal schwannomas

Ramina

Mattei

Sória

et al. 2008

FOC

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Object The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension. Methods A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year. Results Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively. Conclusions The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.

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Section: Discussionmentioning

confidence: 99%

Surgical management of trigeminal schwannomas

Ramina

Mattei

Sória

et al. 2008

FOC

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“…Radiosurgery has been shown to be an excellent alternative for the management of selected patients with intracranial schwannomas (Cokkeser et al, 2000, Zhang et al, 2002, Ramina et al, 2005b, Martin et al, 2007, Bakar, 2008, Hamm et al, 2008, Cho et al, 2009, Fukuda et al, 2009, Safavi-Abbasi et al, 2010. One patient (case 8) in this series had a previous surgery for her triple DSJFS and a gamma knife (2007) for the residual tumour elsewhere, but the residual tumour was larger than the volume limits of gamma knife and a reoperation with tumour resection was necessary.…”

Section: Radiosurgerymentioning

confidence: 92%

“…The intracranial components of the tumour usually present with cystic degeneration. Angiography is not absolutely necessary, but magnetic resonance venography is useful in assessing the patency of the jugular bulb (Matsushima et al, 1989, Samii et al, 1995, Netterville et al, 1998, Hamm et al, 2008. We have not investigated the venous anatomy of tumours Fig.…”

Section: Presentation and Diagnosismentioning

confidence: 97%

Triple dumbbell-shaped jugular foramen schwannomas

Wan

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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“…Standard procedure The experience of several institutions with SRS for nonvestibulocochlear schwannomas, including relatively large series, has been published in recent years [21][22][23][24][25][26]. These investigators have used both single SRS (Gamma Knife [Elekta Instruments, Norcross, GA] or linear accelerators) and fractionated SRS (CyberKnife [Accuray, Inc., Sunnyvale, CA] or arc-based linear accelerators), primarily depending on the institution preference, as well as the characteristics of the tumors.…”

Section: Interventional Proceduresmentioning

confidence: 99%

Nonvestibulocochlear Cranial Nerve Schwannomas

Mejico

2010

Curr Treat Options Neurol

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Nonvestibulocochlear cranial nerve schwannomas traditionally have been managed by surgical excision. Although debulking surgery is still considered the first treatment option for larger tumors, stereotactic radiosurgery is now preferred for smaller tumors because of its high tumor control rate and low treatment-related morbidity. Furthermore, an initial period of radiologic and clinical observation following the diagnosis should be strongly considered for smaller tumors because some may not grow or may grow at a slow rate. Medical management of tumor-associated symptoms (when present) should not be ignored. Most importantly, the time has come to embark on the first randomized controlled trials comparing clinical and radiologic observation, surgery, and radiosurgery in the management of cranial nerve schwannomas.

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Stereotactic Radiotherapy for the Treatment of Nonacoustic Schwannomas

Abstract: SRT is a low-risk and effective treatment option for intracranial neuromas. Particularly in cases of sinus cavernous-invading trigeminal and in jugular foramen tumors, SRT can be the treatment of choice. Concerning tumor regression, SRT is as effective as RS.

Cited by 30 publications

References 30 publications

Surgical management of trigeminal schwannomas

Surgical management of trigeminal schwannomas

Triple dumbbell-shaped jugular foramen schwannomas

Nonvestibulocochlear Cranial Nerve Schwannomas

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