Intratumoral hemorrhage in jugular foramen schwannoma after stereotactic radiosurgery: A case report

Background: Clinically significant intratumoral hemorrhage is a rare complication of stereotactic radiosurgery (SRS) for benign tumors. Case Description: Here, we present the case of a 64-year-old man who underwent SRS for a relatively large dumbbell-shaped left jugular foramen schwannoma (JFS) and thereafter developed intratumoral hemorrhage. On post-SRS day 3, he developed lower cranial nerve palsies with radiographically evident tumor expansion. His neurological conditions had gradually improved thereafter; however, he suddenly developed headache, dizziness, and mild hearing deterioration at 7 months due to intratumoral hemorrhage. We managed the patient conservatively, and eventually, his symptoms improved except for slight ataxia and hearing deterioration. Follow-up images at 4 years from SRS demonstrated significant tumor shrinkage. This is the first report describing intratumoral hemorrhage after SRS for JFS. Conclusion: Transient expansion of the tumor and subsequent venous stasis around the tumor may have played a role in the hemorrhage. Intratumoral hemorrhage should be considered as a rare, but potential complication of SRS for JFSs.

Download Full-text

Intratumoral Hemorrhage in Jugular Foramen Schwannoma after Stereotactic Radiosurgery: A Case Report

10.21203/rs.3.rs-45418/v1 ◽

2020 ◽

Author(s):

Mariko Kawashima ◽

Hirotaka Hasegawa ◽

Masahiro Shin ◽

Yuki Shinya ◽

Nobuhito Saito

Keyword(s):

Stereotactic Radiosurgery ◽

Rare Complication ◽

Jugular Foramen ◽

Venous Stasis ◽

Lower Cranial Nerve ◽

Intratumoral Hemorrhage ◽

Cranial Nerve Palsies ◽

Neurological Conditions ◽

Clinically Significant

Abstract Background: Clinically significant intratumoral hemorrhage is an extremely rare complication of stereotactic radiosurgery (SRS) for benign tumors.Case Presentation:Here, we present the case of a 64-year-old man who underwent SRS for a relatively large dumbbell-shaped left jugular foramen schwannoma and thereafter developed intratumoral hemorrhage. On post-SRS day 3, he developed lower cranial nerve palsies with radiographically evident tumor expansion. His neurological conditions had gradually improved thereafter; however, he suddenly developed headache, dizziness, and mild hearing deterioration at seven months due to intratumoral hemorrhage. We managed the patient conservatively, and eventually his symptoms improved except for slight ataxia and hearing deterioration. Follow-up images at three years from SRS demonstrated significant tumor shrinkage. This is the first report describing intratumoral hemorrhage after SRS for jugular foramen schwannoma.Conclusions:Transient expansion of the tumor and subsequent venous stasis around the tumor may have played a role in the hemorrhage. Intratumoral hemorrhage should be considered as a rare but potential complication of SRS for jugular foramen schwannomas.

Download Full-text

Long-Term Outcome Following Stereotactic Radiosurgery for Glomus Jugulare Tumors: A Single Institution Experience of 20 Years

Neurosurgery ◽

10.1093/neuros/nyx566 ◽

2017 ◽

Vol 83 (5) ◽

pp. 1007-1014 ◽

Cited By ~ 7

Author(s):

Mayur Sharma ◽

Antonio Meola ◽

Sushma Bellamkonda ◽

Xuefei Jia ◽

Joshua Montgomery ◽

...

Keyword(s):

Hearing Loss ◽

Stereotactic Radiosurgery ◽

Tumor Volume ◽

Benign Tumors ◽

Tumor Diameter ◽

Long Term Outcome ◽

Lower Cranial Nerve ◽

Glomus Jugulare

Abstract BACKGROUND Glomus jugulare tumors (GJTs) are rare benign tumors, which pose significant treatment challenges due to proximity to critical structures. OBJECTIVE To evaluate the long-term clinical and radiological outcome in patients undergoing stereotactic radiosurgery (SRS) for GJTs through retrospective study. METHODS Forty-two patients with 43 GJTs were treated using Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) at our institute from 1997 to 2016. Clinical, imaging, and radiosurgery data were collected from an institutional review board approved database. RESULTS Most patients were females (n = 35, 83.3%) and median age was 61 yr (range 23-88 yr). Median tumor volume and diameter were 5 cc and 3 cm, respectively, with a median follow-up of 62.3 mo (3.4-218.6 mo). Overall, 20 patients (47.6%) improved clinically and 14 (33.3%) remained unchanged at last follow-up. New onset or worsening of hearing loss was noted in 6 patients (17.2%) after SRS. The median prescription dose to the tumor margin was 15 Gy (12-18 Gy). Median reduction in tumor volume and maximum tumor diameter at last follow-up was 33.3% and 11.54%, respectively. The 5-yr and 10-yr tumor control rates were 87% ± 6% and 69% ± 13%, respectively. There was no correlation between maximum or mean dose to the internal acoustic canal and post-GK hearing loss (P > .05). CONCLUSION SRS is safe and effective in patients with GJTs and results in durable, long-term control. SRS has lower morbidity than that associated with surgical resection, particularly lower cranial nerve dysfunction, and can be a first-line management option in these patients.

Download Full-text

Posttraumatic Delayed Jugular Foramen Syndrome in a Toddler

Neuropediatrics ◽

10.1055/s-0040-1722684 ◽

2021 ◽

Author(s):

Cristina Toledo-Gotor ◽

Nerea Gorría ◽

Miren Oscoz ◽

Katia Llano ◽

Pablo la Fuente Rodríguez-de ◽

...

Keyword(s):

Physical Examination ◽

Cranial Nerves ◽

Jugular Foramen ◽

Exceptional Case ◽

Cerebellar Tonsil ◽

Occipital Condyle ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies ◽

Blunt Head Trauma ◽

Condyle Fracture

Abstract Background Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures in older children and adults, but no clinical details of other possible mechanisms have been described in infants. Case Report A 33-month-old boy suffered blunt head trauma. A bilateral skull base fracture was diagnosed, with favorable outcome during the first days after trauma. On the sixth day, the patient began to refuse drinking and developed hoarseness. Physical examination and additional investigations revealed paralysis of left VII, IX, X, and XI cranial nerves. A follow-up computed tomography (CT) scan disclosed a left petrous bone fracture involving the lateral margin of the jugular foramen, and a cranial magnetic resonance imaging (MRI) study showed a left cerebellar tonsil contusion. He improved after methylprednisolone was started. Three months later, he was asymptomatic, although mild weakness and atrophy of the left sternocleidomastoid and trapezius muscles remained 1 year later. Discussion A posttraumatic “jugular foramen syndrome” is rare in children, but it has been reported shortly after occipital condyle fracture, affecting mainly IX, X, and XI cranial nerves. In this toddler, delayed symptoms appeared with unilateral involvement. While an occipital fracture was ruled out, neuroimaging findings suggest the hypothesis of a focal contusion as a consequence of a coup-contrecoup injury. Conclusion This exceptional case highlights the importance of gathering physical examination, anatomical correlation, and neuroimaging to yield a diagnosis.

Download Full-text

Biologically effective dose correlates with linear tumor volume changes after upfront single-fraction stereotactic radiosurgery for vestibular schwannomas

Neurosurgical Review ◽

10.1007/s10143-021-01538-w ◽

2021 ◽

Author(s):

Constantin Tuleasca ◽

Mohamed Faouzi ◽

Philippe Maeder ◽

Raphael Maire ◽

Jonathan Knisely ◽

...

Keyword(s):

Standard Deviation ◽

Effective Dose ◽

Stereotactic Radiosurgery ◽

Tumor Volume ◽

Vestibular Schwannomas ◽

Benign Tumors ◽

Biologically Effective Dose ◽

Volume Changes ◽

Single Fraction

AbstractVestibular schwannomas (VSs) are benign, slow-growing tumors. Management options include observation, surgery, and radiation. In this retrospective trial, we aimed at evaluating whether biologically effective dose (BED) plays a role in tumor volume changes after single-fraction first intention stereotactic radiosurgery (SRS) for VS. We compiled a single-institution experience (n = 159, Lausanne University Hospital, Switzerland). The indication for SRS was decided after multidisciplinary discussion. Only cases with minimum 3 years follow-up were included. The Koos grading, a reliable method for tumor classification was used. Radiosurgery was performed using Gamma Knife (GK) and a uniform marginal prescription dose of 12 Gy. Mean BED was 66.3 Gy (standard deviation 3.8, range 54.1–73.9). The mean follow-up period was 5.1 years (standard deviation 1.7, range 3–9.2). The primary outcome was changes in 3D volumes after SRS as function of BED and of integral dose received by the VS. Random-effect linear regression model showed that tumor volume significantly and linearly decreased over time with higher BED (p < 0.0001). Changes in tumor volume were also significantly associated with age, sex, number of isocenters, gradient index, and Koos grade. However, the effect of BED on tumor volume change was moderated by time after SRS and Koos grade. Lower integral doses received by the VSs were inversely correlated with BED in relationship with tumor volume changes (p < 0.0001). Six (3.4%) patients needed further intervention. For patients having uniformly received the same marginal dose prescription, higher BED linearly and significantly correlated with tumor volume changes after SRS for VSs. BED could represent a potential new treatment paradigm for patients with benign tumors, such as VSs, for attaining a desired radiobiological effect. This could further increase the efficacy and decrease the toxicity of SRS not only in benign tumors but also in other SRS indications.

Download Full-text

GP.05 The risk of malignancy after stereotactic radiosurgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.80 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S9-S9

Author(s):

AM Wolf ◽

K Naylor ◽

D Kondziolka

Keyword(s):

Stereotactic Radiosurgery ◽

Incidence Rate ◽

Malignant Transformation ◽

The United States ◽

Benign Tumors ◽

Long Term Follow Up ◽

Risk Of Malignancy ◽

Associated Malignancy

Background: A major concern of patients undergoing Gamma Knife radiosurgery (GKS) for benign tumors and other conditions is the risk of a separate secondary malignancy or malignant -transformation. The incidence of radiosurgery-associated malignancy based on long-term follow-up remains unknown. Methods: We conducted a population-based cohort study to estimate the incidence rate of both malignant transformation and a separate radiation-associated malignancy in patients undergoing GKS from 1987 to 2016 at 5 centers. Results: 11 527 patients underwent radiosurgery for meningioma (n=3261), arteriovenous malformation (n=2868), trigeminal neuralgia (n=1982), vestibular schwannoma (n=1957), pituitary adenoma (n=1193), other (n=266). The follow-up time ranged from 0.3 to 23.8 years. Four cases of malignant transformation and 3 new malignant brain tumors were reported, two of which were not within the irradiated field. The incidence of malignant transformation was 6.6 per 100 000 patient-years and of new malignancy, either locally or distant, was 5 in 100 000 patient-years. These risks are not higher than the Central Brain Tumor Registry of the United States derived annual incidence rate of all primary malignant CNS tumors of 7.15 per 100 000. Conclusions: Physicians can safely counsel patients that the risk of malignancy after stereotactic radiosurgery remains extremely low, even at long-term follow-up of greater than 10 years.

Download Full-text

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

Download Full-text

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine

Neurosurgical FOCUS ◽

10.3171/foc.2003.14.5.17 ◽

2003 ◽

Vol 14 (5) ◽

pp. 1-5 ◽

Cited By ~ 59

Author(s):

Peter C. Gerszten ◽

Cihat Ozhasoglu ◽

Steven A. Burton ◽

William J. Vogel ◽

Barbara A. Atkins ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Tumor Volume ◽

Surgical Techniques ◽

Outpatient Setting ◽

Neurological Deficits ◽

Benign Tumors ◽

Minimal Risk ◽

Single Fraction ◽

Spinal Lesions

Object The role of stereotactic radiosurgery in the treatment of benign intracranial lesions is well established. Its role in the treatment of benign spinal lesions is more limited. Benign spinal lesions should be amenable to radiosurgical treatment similar to their intracranial counterparts. In this study the authors evaluated the effectiveness of the CyberKnife for benign spinal lesions involving a single-fraction radiosurgical technique. Methods The CyberKnife is a frameless radiosurgery system in which an orthogonal pair of x-ray cameras is coupled to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, whereby the therapy beam is guided to the intended target without the use of frame-based fixation. Cervical spine lesions were located and tracked relative to skull osseous landmarks; lower spinal lesions were tracked relative to percutaneously placed fiducial bone markers. Fifteen patients underwent single-fraction radiosurgery (12 cervical, one thoracic, and two lumbar). Histological types included neurofibroma (five cases), paraganglioma (three cases), schwannoma (two cases), meningioma (two cases), spinal chordoma (two cases), and hemangioma (one case). Radiation dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographic tumor volume with no margin. The tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 16 Gy). Tumor volume ranged from 0.3 to 29.3 ml (mean 6.4 ml). Spinal canal volume receiving more than 8 Gy ranged from 0.0 to 0.9 ml (mean 0.2 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Pain improved in all patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging (mean 12 months). Conclusions Spinal stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of benign spinal lesions. Its major potential benefits are the relatively short treatment time in an outpatient setting and the minimal risk of side effects. This new technique offers an alternative therapeutic modality for the treatment of a variety of benign spinal neoplasms in cases in which surgery cannot be performed, in cases with previously irradiated sites, and in cases involving lesions not amenable to open surgical techniques or as an adjunct to surgery.

Download Full-text

Cranial Nerve Preservation and Outcomes after Stereotactic Radiosurgery for Jugular Foramen Schwannomas

Neurosurgery ◽

10.1227/01.neu.0000279726.90650.6d ◽

2007 ◽

Vol 61 (1) ◽

pp. 76-81 ◽

Cited By ~ 37

Author(s):

Juan J. Martin ◽

Douglas Kondziolka ◽

John C. Flickinger ◽

David Mathieu ◽

Ajay Niranjan ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cranial Nerve ◽

Gamma Knife Radiosurgery ◽

Jugular Foramen ◽

Tumor Control ◽

Lower Cranial Nerve ◽

Nerve Preservation ◽

Cranial Nerve Function ◽

Cranial Neuropathies ◽

Cranial Nerve Preservation

Abstract OBJECTIVE Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas. METHODS Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively. RESULTS None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery. CONCLUSION Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.

Download Full-text

Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis

Journal of Neurosurgery ◽

10.3171/2019.4.jns19598 ◽

2020 ◽

Vol 133 (2) ◽

pp. 291-301

Author(s):

Brian M. Shear ◽

Lan Jin ◽

Yawei Zhang ◽

Wyatt B. David ◽

Elena I. Fomchenko ◽

...

Keyword(s):

Recurrence Rate ◽

Meta Analysis ◽

Systemic Review ◽

Benign Tumors ◽

Recurrence Rates ◽

Mixed Effect ◽

Risk Of Recurrence ◽

Epidermoid Tumor ◽

Cranial Nerve Palsies

OBJECTIVEIntracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR.METHODSThe authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models.RESULTSOverall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008).CONCLUSIONSSTR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

Download Full-text

Late Pseudo-Exacerbation of Myasthenia Gravis Due to Ectopic Thymoma Invading Lower Cranial Nerves

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100030018 ◽

1990 ◽

Vol 17 (1) ◽

pp. 46-48 ◽

Cited By ~ 7

Author(s):

Gregg MacLean ◽

Alan Guberman ◽

Antonio Giulivi

Keyword(s):

Myasthenia Gravis ◽

Cranial Nerve ◽

Cranial Nerves ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Cervical Mass ◽

Ectopic Thymoma ◽

Cranial Nerve Palsies ◽

Lower Cranial Nerves ◽

Repeated Aspiration

ABSTRACT:Dysarthria, dysphagia and repeated aspiration in a 54-year-old woman diagnosed and treated for myasthenia gravis 7 years earlier were initially thought to represent a late exacerbation of myasthenia. A cervical mass invading the jugular foramen and causing multiple lower cranial nerve palsies was biopsied and found to represent invasive ectopic thymoma.

Download Full-text