GAMMA KNIFE RADIOSURGERY FOR FACIAL SCHWANNOMAS

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1102-1105 ◽  
Author(s):  
Ricky Madhok ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Effective Management ◽  
Facial Weakness ◽  
Fractionated Radiotherapy ◽  
Muscle Twitching ◽  
Facial Function

Abstract OBJECTIVE Patients who have a schwannoma of the facial nerve (facial schwannoma, facial neuroma) can be managed with observation, surgical resection, stereotactic radiosurgery, or fractionated radiotherapy. Attempted complete resection is associated with facial weakness. The role of radiosurgery in these patients remains to be defined. METHODS We reviewed the clinical and imaging outcomes in patients who underwent gamma knife radiosurgery for a facial schwannoma. RESULTS Six patients had radiosurgery and were followed for a mean and median of 46.6 and 61.5 months, respectively (21–85 months). Three had a previous resection, and in 3 the diagnosis was made based on clinical and imaging criteria. All patients had facial nerve symptoms (5 had weakness and 1 had muscle twitching). House-Brackmann grades before radiosurgery were as follows: 1 (n = 1), 2 (n = 3), 3 (n = 1), and 6 (n = 1). The radiosurgery margin dose was 12 or 12.5 Gy. On later imaging, 3 tumors had regressed (with the longest follow-up duration) and 3 were unchanged. All patients had preservation of their preradiosurgery facial function. No other adverse effects were noted and all patients maintained their preradiosurgery level of hearing. CONCLUSION Over a mean of almost 4 years of follow-up, radiosurgery was shown to be a safe and effective management for residual and newly diagnosed facial schwannomas.

Evaluation of Fractionated Radiotherapy and Gamma Knife Radiosurgery in Cavernous Sinus Meningiomas: Treatment Strategy

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 873-886 ◽  
Author(s):  
Philipe Metellus ◽  
Jean Regis ◽  
Xavier Muracciole ◽  
Stephane Fuentes ◽  
Henry Dufour ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Treatment Strategy ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Fractionated Radiotherapy ◽  
Group I ◽  
Group Ii

Abstract OBJECTIVE: To investigate the respective role of fractionated radiotherapy (FR) and gamma knife stereotactic (GKS) radiosurgery in cavernous sinus meningioma (CSM) treatment. METHODS: The authors report the long-term follow-up of two populations of patients harboring CSMs treated either by FR (Group I, 38 patients) or GKS radiosurgery (Group II, 36 patients). There were 31 females with a mean age of 53 years in Group I and 29 females with a mean age of 51.2 years in Group II. In 20 patients (Group I) and 13 patients (Group II), FR and GKS radiosurgery were performed as an adjuvant treatment. In 18 patients (Group I) and in 23 patients (Group II), FR and GKS radiosurgery were performed as first line treatment. In our early experience with GKS radiosurgery (1992, date of gamma knife availability in the department), patients with tumors greater than 3 cm, showing close relationship with the optic apparatus (<3 mm) or skull base dural spreading, were treated by FR. Secondarily, with the advent of new devices and our growing experience, these criteria have evolved. RESULTS: The median follow-up period was 88.6 months (range, 42–168 mo) for Group I and 63.6 months (range, 48–92 mo) for Group II. According to Sekhar's classification, 26 (68.4%) patients were Grade III to IV in Group I and 10 (27.8%) patients in Group II (P < 0.05); 23 (60.5%) patients had extensive lesions in Group I and 7 (19.4%) patients in Group II (P < 0.05). Mean tumor volume was 13.5 cm3 in Group I and 5.2 cm3 in Group II (P < 0.05). Actuarial progression-free survival was 94.7% and 94.4% in Group I and II, respectively. Clinically, improvement was seen for 24 (63.2%) patients in Group I and for 21 (53.8%) patients in Group II (P > 0.05). Radiologically, 11 (29%, Group I) patients and 19 (Group II, 52.7%) patients showed tumor shrinkage (P = 0.04). Transient morbidity was 10.5% in Group I and 2.8% in Group II. Permanent morbidity was 2.6% in Group I and 0% in Group II. CONCLUSION: FR and GKS radiosurgery are safe and efficient techniques in treatment of CSMs, affording comparable satisfactory long-term tumor control. However, GKS radiosurgery provides better radiological response, is far more convenient, and fits into most patients lives much better than FR. Therefore, in the authors' opinion, GKS radiosurgery should be advocated in first intention for patients with CSMs, whereas conventional radiotherapy should be reserved for cases that are not amenable to this technique, thus making these two therapeutic modalities not alternative but complementary tools in CS meningioma treatment strategy.

scholarly journals Gamma Knife Surgery for Facial Nerve Schwannomas

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 853-859 ◽  
Author(s):  
Claude F. Litre ◽  
Grégoire P. Gourg ◽  
Manabu Tamura ◽  
Driss Mdarhri ◽  
Adil Touzani ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Facial Palsy ◽  
Radical Resection ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Medium Size ◽  
Functional Evaluation ◽  
Facial Function

Abstract OBJECTIVE Radical resection of facial nerve schwannomas classically implies a high risk of severe facial palsy. Owing to the rarity of facial palsy after gamma knife surgery (GKS) of vestibular schwannomas, functional evaluation after GKS seems rational in this specific group of patients. To our knowledge, no previous similar evaluation exists in the literature. METHODS Of 1783 schwannomas of the cerebellopontine angles treated by GKS at Timone University Hospital between July 1992 and May 2003, 11 were diagnosed as originating from the facial nerve. Criteria for this diagnosis were the involvement of the tympanic or mastoid segment of the facial nerve (n = 9) and/or preoperative observation of a facial nerve deficit that had occurred during previous microsurgery (two patients). The rare occurrence of facial palsy after vestibular schwannoma radiosurgery, usually within 18 months of treatment, has been considered only in the patients with more than 2 years of follow-up (n = 9). RESULTS Six of these patients experienced a previous spontaneous facial palsy on one (n = 4) or several occasions (n = 2). A normal motor facial function was observed in only three patients before GKS (House-Brackmann Grade II in six patients, Grade III in one patient, Grade IV in one patient). The median follow-up period was 39 months (range, 18–84 mo). At the time of the last follow-up examination, no patients had developed a new facial palsy or experienced deterioration of a preexisting facial palsy and three patients had improvement of a preoperative facial palsy. Ten out of the 11 tumors are stable or decreased in size; in the other, a microsurgical resection of the tumor had been recommended owing to the development of a cyst. Clinical management owing to the specificity and heterogeneity of this group of patients has required the development of an original classification of four anatomic subtypes presenting different clinical and surgical difficulties. CONCLUSION This first study demonstrates that radiosurgery allows treatment of these patients while preserving normal motor facial function. Such an advantage should lead to the consideration of GKS as a first treatment option for small- to medium-size facial nerve schwannomas.

Midterm Prognosis and Surgical Implication of Clival Chordoma after an Extended Transsphenoidal Tumor Removal and Gamma Knife Radiosurgery

2020 ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Hidefumi Jokura ◽  
Teiji Tominaga
Keyword(s):  
Survival Rate ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Total Removal ◽  
Tumor Removal ◽  
Clinical Investigations ◽  
Extended Transsphenoidal Approach ◽  
Prophylactic Irradiation

Abstract Background: Treatment for chordoma by surgery alone is often ineffective, so surgery and irradiation is often performed with a reported 5-year survival rate of 60-75%. The clinical course varies; however, disease rarity has prevented large number clinical investigations. Methods: Nineteen patients suffering from clival chordomas were retrospectively investigated. They were initially treated with maximal tumor removals by extended transsphenoidal approach. When total removal was achieved prophylactic irradiation was not performed. If tumor remnants or recurrence was confirmed, gamma knife (GK) was performed. Follow-up periods ranged from 9 to 224 months (mean 85.4 months). Results: Total removal was achieved in 10 patients; however, 4 patients suffered recurrence and required GK. Overall progression free intervals were 9 to 151 months (mean 59.9 mzonths). GK was applied for 11 patients with a 50 % isodose of 13 to 18 Gy (mean 15.4 Gy). Eight patients remained progression free, but 3 patients suffered repeated local recurrence and died from tumor related complications. Overall survival was 9 to 224 months (mean 90.9 months). Eighteen patients survived more than 5 years with the exception of one male patient, who died of lung cancer 36 months after the initial treatment (5-year survival rate 94.7 %). The results indicated that sex (males), those given more than 15 Gy of a 50% isodose by GK, and prophylactic brain scanning were significant favorable prognostic factors. Conclusions: The favorable outcomes in this investigation may indicate value for early detection and early treatment. The role of surgery may be adequate conditioning for enough dose of GK.

scholarly journals Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

2015 ◽  
Vol 123 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Jason P. Sheehan ◽  
Hideyuki Kano ◽  
Zhiyuan Xu ◽  
Veronica Chiang ◽  
David Mathieu ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Rank Test ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Log Rank Test

OBJECT Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. Resection can be undertaken, but the tumor’s intimate association with the facial nerve makes resection with neurological preservation quite challenging. Stereotactic radiosurgery (SRS) has been used to treat FNSs, and this study evaluates the outcome of this approach. METHODS At 8 medical centers participating in the North American Gamma Knife Consortium (NAGKC), 42 patients undergoing SRS for an FNS were identified, and clinical and radiographic data were obtained for these cases. Males outnumbered females at a ratio of 1.2:1, and the patients’ median age was 48 years (range 11–76 years). Prior resection was performed in 36% of cases. The mean tumor volume was 1.8 cm3, and a mean margin dose of 12.5 Gy (range 11–15 Gy) was delivered to the tumor. RESULTS At a median follow-up of 28 months, tumor control was achieved in 36 (90%) of the 40 patients with reliable radiographic follow-up. Actuarial tumor control was 97%, 97%, 97%, and 90% at 1, 2, 3, and 5 years postradiosurgery. Preoperative facial nerve function was preserved in 38 of 42 patients, with 60% of evaluable patients having House-Brackmann scores of 1 or 2 at last follow-up. Treated patients with a House-Brackmann score of 1 to 3 were more likely to demonstrate this level of facial nerve function at last evaluation (OR 6.09, 95% CI 1.7–22.0, p = 0.006). Avoidance of temporary or permanent neurological symptoms was more likely to be achieved in patients who received a tumor margin dose of 12.5 Gy or less (log-rank test, p = 0.024) delivered to a tumor of ≤ 1 cm3 in volume (log-rank test, p = 0.01). CONCLUSIONS Stereotactic radiosurgery resulted in tumor control and neurological preservation in most FNS patients. When the tumor is smaller and the patient exhibits favorable normal facial nerve function, SRS portends a better result. The authors believe that early, upfront SRS may be the treatment of choice for small FNSs, but it is an effective salvage treatment for residual/recurrent tumor that remain or progress after resection.

scholarly journals Is Salvage Surgery for Large Vestibular Schwannomas After Failed Gamma-knife Radiosurgery More Challenging?

2021 ◽  
Author(s):  
Lucas Troude ◽  
Mohamed Boucekine ◽  
Anne Balossier ◽  
Guillaume Baucher ◽  
Jean-Pierre Lavieille ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Salvage Surgery ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Failure Group

Abstract Objectives: In order to verify whether a previous Gamma-Knife surgery (GKS) treatment could influence the oncological and functional outcome in large vestibular schwannoma (VS) surgery, we have compared group of patients operated on for large VS after failed-GKS to a group of genuine VS that underwent the same functional nerve-sparing resection technique regimen in the same period.Methods: Single center retrospective cohort study of 23 consecutive GKS-failure and 170 genuine VS patients operated on between April 2003 and March 2019. After resection, patients were allocated to a Wait-&-rescan or an upfront GKS policy.Results: At last follow-up examination, the facial nerve function was good (House-Brackmann Grades I or II) in 95% of the GKS-failure and 84% of the genuine VS patients (p=.25). The median volume of tumor residue was .56cc in the GKS-failure group, and .62cc in the genuine VS group (p=.70). Tumor control was achieved in 91% and 83% of cases with a mean follow-up of 74 and 63 months in the GKS-failure and the genuine VS populations, respectively. The 1-, 5- and 7-year progression free survival were 100%, 95% & 85% respectively in the GKS-failure group, and 97%, 80% & 81% in the genuine VS group (p=.27).Conclusion: Despite significant modifications of the microsurgical environment associated to salvage surgery after GKS-failure, a functional nerve-sparing resection is an effective strategy to optimize the results on facial nerve function, with similar long-term tumor control to those observed in the genuine VS population.

scholarly journals Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 198-202 ◽  
Author(s):  
Roman Liscak ◽  
Dusan Urgosik ◽  
Tomas Chytka ◽  
Gabriela Simonova ◽  
Josef Novotny ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Glomus Tumor ◽  
Gamma Knife Radiosurgery ◽  
Neurological Deficits ◽  
Long Term Results ◽  
Morbidity Rate ◽  
Glomus Tumors ◽  
Fractionated Radiotherapy

ObjectGlomus tumors usually display indolent behavior, and the effectiveness of radiation in stopping their growth can be assessed after long-term follow-up. Currently only midterm results of radiosurgery are available, so the authors included patients treated by Gamma Knife at least 10 years ago in this study to obtain a perspective of long-term results.MethodsDuring the period from 1992 to 2003, the Gamma Knife was used to treat 46 patients with glomus tumors. The age of the patients ranged from 21 to 79 years (median 56 years). Gamma Knife radiosurgery was the primary treatment in 17 patients (37%). Open surgery preceded radiosurgery in 46% of cases, embolization in 17%, and fractionated radiotherapy in 4%. The volume of the tumor ranged from 0.2 to 24.3 cm3 (median 3.6 cm3). The minimal dose to the tumor margin ranged between 10 and 30 Gy (median 20 Gy).ResultsOne patient was lost for follow-up after radiosurgery. Clinical follow-up was available in 45 patients and 44 patients were followed with MRI in a follow-up period that ranged from 12 to 217 months (median 118 months). Neurological deficits improved in 19 (42%) of 45 patients and deteriorated in 2 patients (4%). Tumor size decreased in 34 (77%) of 44 patients with imaging follow-up, while an increase in volume was observed in 1 patient (2%) 182 months after radiosurgery and Gamma Knife treatment was repeated. One patient underwent another Gamma Knife treatment for secondary induced meningioma close to the glomus tumor 98 months after initial radiosurgical treatment. Seven patients died 22–96 months after radiosurgery (median 48 months), all for unrelated reasons.ConclusionsRadiosurgery has proved to be a safe treatment with a low morbidity rate and a reliable long-term antiproliferative effect.

scholarly journals Gamma Knife Radiosurgery for Large Vestibular Schwannomas: A Canadian Experience

2013 ◽  
Vol 40 (3) ◽  
pp. 342-347 ◽  
Author(s):  
F. A. Zeiler ◽  
M. Bigder ◽  
A. Kaufmann ◽  
P. J. McDonald ◽  
D. Fewer ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Maximal Diameter

Object:To review our institutional experience with Gamma Knife (GK) stereotactic radiosurgery in treating large vestibular schwannomas (VS) of 3 to 4 cm diameter.Methods:We conducted a retrospective cohort review of all patients treated with GK for VS at our institution between November 2003 and March 2012. Data on age, sex, VS volume, location and maximal diameter, House-Brackmann (HB) facial nerve scores pre and post-GK, Gardner-Robertson (GR) hearing score pre and post-GK, GK treatment parameters, VS response time, complications and clinical outcome was recorded.Results:A total of 28 patients during the defined time period were identified. Three patients were lost to follow-up. Mean follow-up was 34.5 months. Tumor control occurred in 92%, and was maintained in 85.7% at two years. Facial nerve or hearing preservation occurred in all treated compared to pre-GK status, as per HB and GR grading. Transient complications occurred in 80%. Temporary vestibular dysfunction occurred in seven patients (28%). One patient (4%) had the permanent complication of worsening pre-GK hemifacial spasm. Four patients (16%) developed hydrocephalus post-GK.Conclusion:GK stereotactic radiosurgery as a primary treatment modality for large VS can provide acceptable tumor control rates with good facial nerve and hearing preservation, and low complication rates.

scholarly journals Single-session Gamma Knife radiosurgery for optic pathway/hypothalamic gliomas

2016 ◽  
Vol 125 (Supplement_1) ◽  
pp. 50-57 ◽  
Author(s):  
Amr M. N. El-Shehaby ◽  
Wael A. Reda ◽  
Khaled M. Abdel Karim ◽  
Reem M. Emad Eldin ◽  
Ahmed M. Nabeel
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Optic Pathway ◽  
Single Session ◽  
Effective Treatment Option ◽  
Fractionated Radiotherapy ◽  
Prescription Dose

OBJECTIVEBecause of their critical and central location, it is deemed necessary to fractionate when considering irradiating optic pathway/hypothalamic gliomas. Stereotactic fractionated radiotherapy is considered safer when dealing with gliomas in this location. In this study, the safety and efficacy of single-session stereotactic radiosurgery for optic pathway/hypothalamic gliomas were reviewed.METHODSBetween December 2004 and June 2014, 22 patients with optic pathway/hypothalamic gliomas were treated by single-session Gamma Knife radiosurgery. Twenty patients were available for follow-up for a minimum of 1 year after treatment. The patients were 5 to 43 years (median 16 years) of age. The tumor volume was 0.15 to 18.2 cm3 (median 3.1 cm3). The prescription dose ranged from 8 to 14 Gy (median 11.5 Gy).RESULTSThe mean follow-up period was 43 months. Five tumors involved the optic nerve only, and 15 tumors involved the chiasm/hypothalamus. Two patients died during the follow-up period. The tumors shrank in 12 cases, remained stable in 6 cases, and progressed in 2 cases, thereby making the tumor control rate 90%. Vision remained stable in 12 cases, improved in 6 cases, and worsened in 2 cases in which there was tumor progression. Progression-free survival was 83% at 3 years.CONCLUSIONSThe initial results indicate that single-session Gamma Knife radiosurgery is a safe and effective treatment option for optic pathway/hypothalamic gliomas.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

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