Intracranial nonvestibular neurinomas: Young neurosurgeons’ experience

ABSTRACT Background and Objectives: Neurinoma arising from other than nonvestibular cranial nerves is less prevalent. Here we present our experiences regarding the clinical profile, investigations, microneurosurgical management, and the outcome of nonvestibular cranial nerve neurinomas. Materials and Methods: From January 2005 to December 2011, the recorded documents of operated nonvestibular intracranial neurinomas were retrospectively studied for clinical profile, investigations, microneurosurgical management, complications, follow-up, and outcomes. Results: The average follow-up was 24.5 months. Total number of cases was 30, with age ranging from 9 to 60 years. Sixteen cases were males and 14 were females. Nonvestibular cranial nerve schwannomas most commonly originated from trigeminal nerve followed by glossopharyngeal+/vagus nerve. There were three abducent nerve schwannomas that are very rare. There was no trochlear nerve schwannoma. Two glossopharyngeal+/vagus nerve schwannomas extended into the neck through jugular foramen and one extended into the upper cervical spinal canal. Involved nerve dysfunction was a common clinical feature except in trigeminal neurinomas where facial pain was a common feature. Aiming for no new neurodeficit, total resection of the tumor was done in 24 cases, and near-total resection or gross total resection or subtotal resection was done in 6 cases. Preoperative symptoms improved or disappeared in 25 cases. New persistent deficit occurred in 3 cases. Two patients died postoperatively. There was no recurrence of tumor till the last follow-up. Conclusion: Nonvestibular schwannomas are far less common, but curable benign lesions. Surgical approach to the skull base and craniovertebral junction is a often complex and lengthy procedure associated with chances of significant morbidity. But early diagnosis, proper investigations, and evaluation, along with appropriate decision making and surgical planning with microsurgical techniques are the essential factors that can result in optimum outcome.

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Stereotactic Radiosurgery of Cranial Nonvestibular Schwannomas: Results of Single- and Multisession Radiosurgery

Neurosurgery ◽

10.1227/neu.0b013e31820c0474 ◽

2011 ◽

Vol 68 (5) ◽

pp. 1200-1208 ◽

Cited By ~ 15

Author(s):

Clara Y. H. Choi ◽

Scott G. Soltys ◽

Iris C. Gibbs ◽

Griffith R. Harsh ◽

Gordon T. Sakamoto ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Medical Center ◽

Cranial Nerves ◽

Jugular Foramen ◽

Tumor Control ◽

Minimal Risk ◽

Invasive Treatment ◽

Non Invasive

Abstract BACKGROUND: Surgical resection of nonvestibular cranial schwannomas carries a considerable risk of postoperative complications. Stereotactic radiosurgery (SRS) offers a non-invasive treatment alternative. The efficacy and safety of multi-session SRS of nonvestibular cranial schwannomas has not been well studied. OBJECTIVE: To analyze the results of single- and multi-session SRS of nonvestibular cranial schwannomas. METHODS: From 2001 to 2007, 42 lesions in 40 patients were treated with SRS at Stanford University Medical Center, targeting schwannomas of cranial nerves IV (n = 1), V (n = 18), VII (n = 6), X (n = 5), XII (n = 2), jugular foramen (n = 8), and cavernous sinus (n = 2). SRS was delivered to a median marginal dose of 18 Gy (range, 15-33 Gy) in 1 to 3 sessions, targeting a median tumor volume of 3.2 cm3 (range, 0.1-23.7 cm3). The median doses for treatments in 1 (n = 18), 2 (n = 9), and 3 (n = 15) sessions were 17.5, 20, and 18 Gy, respectively. RESULTS: With a median follow-up of 29 months (range, 6-84 months), tumor control was achieved in 41 of the 42 lesions. Eighteen of 42 lesions (43%) decreased in size; 23 tumors (55%) remained stable. There were 2 cases of new or worsening cranial nerve deficits in patients treated in single session; no patient treated with multi-session SRS experienced any cranial nerve toxicity (P = 0.18). CONCLUSION: SRS of nonvestibular cranial schwannomas provides excellent tumor control with minimal risk of complications. There was a trend towards decreased complications with multi-session SRS.

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Long-Term Outcome and Comparison of Treatment Modalities of Temporal Bone Paragangliomas

Cancers ◽

10.3390/cancers13205083 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5083

Author(s):

Erdem Yildiz ◽

Valerie Dahm ◽

Wolfgang Gstoettner ◽

Karl Rössler ◽

Belinda Bauer ◽

...

Keyword(s):

Tumor Growth ◽

Temporal Bone ◽

Treatment Modality ◽

Cranial Nerve ◽

Treatment Modalities ◽

Subtotal Resection ◽

Total Resection ◽

Primary Radiotherapy

Introduction: Temporal bone paragangliomas are rare tumors with high vascularization and usually benign entity. A variety of modalities, including gross total resection, subtotal resection, conventional or stereotactic radiotherapy including gamma-knife, embolization, and wait-and-scan strategy can be considered. The aim of this study was to compare long-term outcomes of different primary treatment modalities in temporal bone paragangliomas. Materials and Methods: Patients with temporal bone paragangliomas treated between 1976 and 2018 at a tertiary referral center were retrospectively analyzed in this study. Collected patient data of 42 years were analyzed and long-term results including interdisciplinary management were assessed. Patient outcomes were compared within the different therapy modalities according to tumor control rate and complications. Clinical characteristics, radiological imaging, tumor extent and location (according to Fisch classification), symptoms, and follow-up were evaluated and a descriptive analysis for each treatment modality was performed. Tumor recurrence or growth progression and respective cranial nerve function before and after therapy were described. Results: A total of 59 patients were treated with a single or combined treatment modality and clinical follow-up was 7 (13) years (median, interquartile range). Of the included patients 45 (76%) were female and 14 (24%) male (ratio 3:1) with a patient age range from 18 to 83 years. Total resection was performed on 31 patients, while 14 patients underwent subtotal resection. Eleven patients were treated with conventional primary radiotherapy or gamma-knife radiosurgery. Pulsatile tinnitus (n = 17, 29%) and hearing impairment (n = 16, 27%) were the most common symptoms in our patient group. Permanent lower cranial nerve deficits were observed only in patients with large tumors (Fisch C and D, n = 14, 24%). Among the 45 patients who were treated surgically, 88% of patients with Fisch A and B paragangliomas had no recurrent disease, while no tumor growth was perceived in 83% of patients with Fisch C and D paragangliomas. Conclusion: In conclusion, we propose surgery as a treatment option for patients with small tumors, due to a high control rate and less cranial nerve deficits compared to larger tumors. Although patients with Fisch C and D temporal bone paraganglioma can be treated surgically, only subtotal resections are possible in many cases. Additionally, frequent occurrence of cranial nerve deficits in those patients and tumor growth progression in long-term follow-up examinations make a combination of the therapy modalities or a primary radiotherapy more suitable in larger tumors.

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Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1606220 ◽

2017 ◽

Vol 79 (02) ◽

pp. 167-172 ◽

Cited By ~ 2

Author(s):

Ahmed Farhoud ◽

Wael Khedr ◽

Hisham Aboul-Enein

Keyword(s):

Cranial Nerves ◽

Postoperative Mortality ◽

Residual Tumor ◽

Retrosigmoid Approach ◽

Subtotal Resection ◽

Total Resection ◽

Surgical Strategies ◽

Epidermoid Cysts ◽

Presenting Symptoms

Objective Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions. Material and Methods The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year. Results There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them. Conclusion The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

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STEREOTACTIC RADIOTHERAPY FOR THE TREATMENT OF NONACOUSTIC SCHWANNOMAS

Neurosurgery ◽

10.1227/01.neu.0000325934.16229.03 ◽

2008 ◽

Vol 62 (suppl_5) ◽

pp. A29-A36 ◽

Cited By ~ 18

Author(s):

Klaus D. Hamm ◽

Markus W. Gross ◽

Antje Fahrig ◽

Gunnar Surber ◽

Martin Henzel ◽

...

Keyword(s):

Stereotactic Radiotherapy ◽

Cranial Nerve ◽

Tumor Volume ◽

Tumor Regression ◽

Cranial Nerves ◽

Jugular Foramen ◽

The Other ◽

Tumor Control ◽

Subtotal Resection ◽

Effective Treatment Option

ABSTRACT OBJECTIVE Nonacoustic schwannomas are rare tumors in contrast to the most common neuromas of Cranial Nerve VIII. The current treatment of choice in these cases is microsurgical resection, but the risk of postoperative complications is high, especially in cavernous sinus-invading tumors. In many of these cases, it is not possible to achieve complete tumor removal, resulting in the probability of recurrences. For those patients, radiosurgery (RS) or stereotactic radiotherapy (SRT) can offer an alternate treatment. METHODS Within a 5-year period (2000–2005), 19 intracranial nonacoustic neuromas were treated with SRT-13 trigeminal neuromas, five neuromas of the lower cranial nerves (jugular foramen), and one located in the orbital region. Of these cases, there were nine women and 10 men who were, on average, 54 years of age (range, 33–83 yr). Eight patients had previously undergone surgery elsewhere and showed progressive tumor growth. All 19 patients were treated with SRT: 15 with normal fractions of 1.8–2 Gy single dose up to 54–59.4 Gy. Their irregular tumor volume ranged from 4.2 to 43.1 ccm (average: 14.1 ccm). Hypofractionation with 6 to 7 × 5 Gy was applied in four cases with an average tumor volume of 4.1 ccm (2.2–6.2 ccm). Clinical results and the efficacy for tumor control with an average follow-up of 35 months (11–63 mo) were evaluated. RESULTS Local tumor control rate was 95% (18 of 19 cases): one patient previously operated on had a recurrence of tumor progression after SRT, followed by a second subtotal resection. A tumor regression was proved in 11 cases (one neuroma disappeared and four patients had tumor shrinkage of more than 50%, the other six experienced shrinkage between 20% and 40%). Within the first 6 months, two patients developed temporarily increased tumor volume as well as a confirmed reaction to irradiation. In one of these two cases, there were mild side effects according to CTC Grade I. No patient experienced a new or increased neurological deficit. Improvement of their cranial nerve disturbances was achieved in 11 of 19 patients and the other eight showed no clinical changes. The mostly moderate trigeminal pain decreased slowly. CONCLUSION 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.

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Surgical Management of Petroclival Meningiomas: Defining Resection Goals Based on Risk of Neurological Morbidity and Tumor Recurrence Rates in 137 Patients

Neurosurgery ◽

10.1227/01.neu.0000153906.12640.62 ◽

2005 ◽

Vol 56 (3) ◽

pp. 546-559 ◽

Cited By ~ 141

Author(s):

Kenneth M. Little ◽

Allan H. Friedman ◽

John H. Sampson ◽

Masahiko Wanibuchi ◽

Takanori Fukushima

Keyword(s):

Cranial Nerve ◽

Tumor Recurrence ◽

Critical Role ◽

Recurrence Rates ◽

Total Resection ◽

Petroclival Region ◽

Petroclival Meningiomas ◽

Increased Risk ◽

Neurological Morbidity

Abstract OBJECTIVE: Meningiomas arising from the petroclival region remain a challenging surgical problem. Because of the substantial risk of neurological morbidity, uniformly pursuing a gross total resection (GTR) to minimize tumor recurrence rates may not be justified. We sought to define optimal resection goals based on risk factors for postoperative neurological morbidity and tumor recurrence rates. METHODS: This series represents our experience with 137 meningiomas arising from the petroclival region resected between June 1993 and October 2002. There were 38 male and 99 female patients with a mean age of 53 years. RESULTS: GTR was achieved in 40% of patients, and near total resection (NTR) was achieved in 40% of patients. One operative death occurred. Twenty-six percent of patients experienced new postoperative cranial nerve deficits, paresis, or ataxia when assessed at a mean follow-up of 8.3 months. The risk of cranial nerve deficits increased with prior resection (P < 0.001), preoperative cranial nerve deficit (P = 0.005), tumor adherence to neurovascular structures (P = 0.046), and fibrous tumor consistency (P = 0.005). The risk of paresis or ataxia increased with prior resection (P = 0.001) and tumor adherence (P = 0.045). Selective NTR rather than GTR in patients with adherent or fibrous tumors significantly reduced the rate of neurological deficits. Radiographic recurrence or progression occurred in 17.6% of patients at a mean follow-up of 29.8 months. Tumor recurrence rates after GTR and NTR did not differ significantly (P = 0.111). CONCLUSION: Intraoperatively defined tumor characteristics played a critical role in identifying the subset of patients with an increased risk of postoperative deficits. By selectively pursuing an NTR rather than a GTR, neurological morbidity was reduced significantly without significantly increasing the rate of tumor recurrence.

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Sphenoorbital meningioma: surgical technique and outcome

Journal of Neurosurgery ◽

10.3171/2010.10.jns101128 ◽

2011 ◽

Vol 114 (5) ◽

pp. 1241-1249 ◽

Cited By ~ 37

Author(s):

Soichi Oya ◽

Burak Sade ◽

Joung H. Lee

Keyword(s):

Surgical Technique ◽

Visual Outcome ◽

Sphenoid Bone ◽

Wide Resection ◽

Tumor Control ◽

Subtotal Resection ◽

Total Resection ◽

Anterior Clinoid Process ◽

Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

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Linear Accelerator Radiosurgery for Nonvestibular Schwannomas

Neurosurgery ◽

10.1227/neu.0b013e318208f3a1 ◽

2011 ◽

Vol 68 (4) ◽

pp. 974-984 ◽

Cited By ~ 15

Author(s):

Matthew M. Kimball ◽

Kelly D. Foote ◽

Frank J. Bova ◽

Yueh-Yun Chi ◽

William A. Friedman

Keyword(s):

Surgical Resection ◽

Cranial Nerve ◽

Linear Accelerator ◽

Jugular Foramen ◽

Symptomatic Improvement ◽

Local Tumor Control ◽

Tumor Control ◽

High Morbidity ◽

Local Tumor

Abstract BACKGROUND: Nonvestibular schwannomas are uncommon tumors of the brain often treated by surgical resection. Surgery may be associated with high morbidity. OBJECTIVE: We present a series of nonvestibular schwannomas treated with linear accelerator radiosurgery during a 19-year period. METHODS: This is a retrospective analysis of patients who underwent treatment of nonvestibular schwannomas at the University of Florida with linear accelerator radiosurgery between August 1989 and February 2008. Forty-nine patients underwent treatment during the study period, and 6 were lost to follow up. The mean age was 51 years (range, 17-82 years), 39% had previous surgical resection, and 67% presented with preradiosurgery cranial nerve deficits. There were 25 trigeminal, 18 jugular foramen, 2 facial, 2 oculomotor, 1 hypoglossal, and 1 high cervical schwannomas. The median tumor volume was 5.3 mL (range, 0.3-24.5 mL), treated with a median dose of 1250 cGy (range, 1000-1500 cGy). Study endpoints were actuarial local tumor control and neurological outcome. RESULTS: Forty-three patients were available for a median follow-up of 37 months (range, 6-210 months). Actuarial local tumor control was 97% at 1 year, 91% at 4.5 years, and 83% at 5 years. There were 4 new cranial nerve deficits (9%) including facial numbness (2 patients), anesthesia dolorosa (1 patient), and facial weakness (1 patient). Thirty-nine percent had documented clinical and/or symptomatic improvement. There were no other morbidity and no mortality with treatment. CONCLUSION: Radiosurgery for nonvestibular schwannomas offers good actuarial local tumor control and has superior morbidity compared with surgical resection. This is the largest linear accelerator radiosurgical series, and the second largest radiosurgical series reported to date.

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Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v18i2.12015 ◽

2012 ◽

Vol 18 (2) ◽

pp. 183-192

Author(s):

Forhad H Chowdhury ◽

Mohammod R Haque ◽

Mahmudul Hasan

Keyword(s):

Cranial Nerve ◽

Cranial Nerves ◽

Young Male ◽

Carotid Bifurcation ◽

Short Review ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies ◽

Cervical Approach ◽

High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

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Microsurgical Treatment of Glossopharyngeal Neuralgia: Case Reports

Neurosurgery ◽

10.1227/00006123-198910000-00018 ◽

1989 ◽

Vol 25 (4) ◽

pp. 630-632 ◽

Cited By ~ 34

Author(s):

Bernardo Fraioli ◽

Vincenzo Esposito ◽

Luigi Ferrante ◽

Lanfranco Trubiani ◽

Pierpaolo Lunardi

Keyword(s):

Vagus Nerve ◽

Cranial Nerve ◽

Open Surgery ◽

Case Reports ◽

Cranial Nerves ◽

Posterior Cranial Fossa ◽

Glossopharyngeal Neuralgia ◽

Neurovascular Compression ◽

Cerebellar Artery ◽

Cranial Fossa

Abstract Three patients with excruciating glossopharyngeal neuralgia underwent microsurgical operations in the posterior cranial fossa. In each patient, neurovascular compression was found involving the posteroinferior cerebellar artery and involving the 9th and 10th cranial nerves. In two of the patients, the compression was caused by arachnoiditis and in the other by an arterial loop. In each patient, neuralgia was successfully eliminated by microvascular decompression and by section of the upper rootlets of the vagus nerve. In one patient, partial section of the 9th cranial nerve was also performed. Because of the frequent involvement of the vagus nerve in the pathogenesis of this condition, open surgery should be preferable to percutaneous thermorhizotomy, which is unable to act selectively on the 10th cranial nerve.

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Intraneural perineurioma of the third cranial nerve: occurrence and identification

Journal of Neurosurgery ◽

10.3171/jns.2006.104.5.824 ◽

2006 ◽

Vol 104 (5) ◽

pp. 824-827 ◽

Cited By ~ 10

Author(s):

Rami Almefty ◽

Bruce L. Webber ◽

Kenan I. Arnautović

Keyword(s):

Schwann Cells ◽

Cranial Nerve ◽

S100 Protein ◽

Cranial Nerves ◽

Onion Bulb ◽

Subtotal Resection ◽

Bulb Formation ◽

Intraneural Perineurioma ◽

Onion Bulb Formation ◽

Third Cranial Nerve Palsy

✓Intraneural perineurioma is a true but rare neoplasm that originates from perineurial cells and mainly affects peripheral nerves. It must be distinguished from other hypertrophic neuropathies that are either inflammatory or demonstrate an onion-bulb formation that originates from Schwann cells. Complying with this strict definition, only three additional cases of cranium-related perineurioma have been identified: two lesions arose extracranially and involved cranial nerves, and one occurred intracranially but did not involve a nerve. The authors describe a 27-year-old woman who presented with left third cranial nerve palsy and was found to harbor a mass lesion in the superior orbital fissure and cavernous sinus. After subtotal resection had been performed, pathological studies confirmed the presence of perineurial tumor cells in a pseudo–onion bulb formation. The cells stained positively for epithelial membrane antigen but not for S100 protein, clearly distinguishing the disease from one that originates in Schwann cells.

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