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 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.

Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E91-E98 ◽  
Author(s):  
Gautam U Mehta ◽  
Gregory P Lekovic ◽  
William H Slattery ◽  
Derald E Brackmann ◽  
Hao Long ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Progression Free Survival ◽  
Functional Improvement ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Multicenter Cohort Study ◽  
Facial Numbness

Abstract BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.

scholarly journals Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.CONCLUSIONSThis long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

scholarly journals Safety and Efficacy of Hypo Fractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma: a Single Institution Retrospective Case Series

2021 ◽  
Author(s):  
Nida Fatima ◽  
Anna La Dine ◽  
Zachary R Barnard ◽  
Katherine Ko ◽  
Kevin Peng ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Case Series ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Nerve Function ◽  
Local Tumor ◽  
Nerve Preservation ◽  
Fractionated Stereotactic Radiosurgery

Abstract Background: In the current era of modern neurosurgery, the treatment strategies have been shifted to “nerve-preservation approaches” for achieving a higher facial and hearing function preservation rate following facial nerve tumors.Objective: We have conducted this novel report on determining the outcome of patients with facial nerve schwannomas (FNS) treated with hypo fractionated stereotactic radiosurgery (hfSRS).Methods: Retrospective chart review of a prospectively maintained database search was conducted. Patients who underwent hfSRS CyberKnife (Accuray Inc, Sunnyvale, California., USA) for FNS were included. Outcomes consisted of tumor control, facial and hearing nerve function as graded by House-Brackmann (HB) and Gardner-Robertson scale, and adverse radiation effects. SPSS 23 was used to perform statistical analysis.Results: With an institutional board review approval, we retrospectively identified 5 patients with FNS [4 intracranial (80%) and 1 extracranial (20%)] treated with hfSRS (2011-2019). Patients received definitive SRS in 3 patients (60.0%) wile adjuvant to surgical resection in 2 patients (40.0%). A median tumor volume of 7.5 cm3 (range, 1.5-19.6 cm3) received a median prescription dose of 23.2 Gy (range, 21-25 Gy) administered in median of 3 fractions (range, 3-5 session). With a median radiographic follow-up of 31.4 months (range, 13.0-71.0 months) and clinical follow-up of 32.6 months (range, 15.1-72.0 months), the local tumor control was 100.0%. At last clinical follow-up, the facial nerve function improved or remained unchanged HB I-II in 80.0% of the patients, while the hearing nerve function improved or remained stable in 100.0% (Gardner-Robertson I-II) of the patients. Temporary clinical toxicity was seen in 3 patients (60.0%) which resolved. None of the patient developed adverse radiation effect.Conclusion: From our case series, hfSRS in FNS seems to be safe and efficacious in terms of local tumor control, and improved facial and hearing nerve function.

Retreatment of vestibular schwannomas with Gamma Knife surgery

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 144-148 ◽  
Author(s):  
Sheri Dewan ◽  
Georg Norén
Keyword(s):  
Facial Nerve ◽  
New England ◽  
Gamma Knife ◽  
Radiation Effects ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Proton Beam Radiotherapy

Object The response rate of vestibular schwannomas (VSs) to radiosurgery has reached the 97% level in several published series. When failure rarely occurs, some controversy has existed as to whether the tumor has to be resected or can be safely retreated with radiosurgery. The authors retrospectively studied the outcome of retreating 11 patients with Gamma Knife surgery (GKS). Methods The authors studied 11 patients at the New England Gamma Knife Center who had undergone GKS as a second radiosurgical treatment for VS from 1994 to 2007. One patient underwent proton-beam radiotherapy as the first treatment, and the other 10 patients had undergone GKS initially. Tumor control (size before and after the first and the second treatment) was evaluated using MR imaging to demonstrate the course after the 2 treatments. Facial nerve function (House–Brackmann grading system), trigeminal nerve function, hearing (Gardner–Robertson classification), and any adverse radiation effects were evaluated. The prescription dose was 12 Gy (11–13.2 Gy) for both treatments. Results Of the 11 patients, 2 showed increase, 1 had no change, and, in 8, the VS decreased in size after the retreatment. One tumor remained unchanged over the first 6 months, but demonstrated signs of internal necrosis. All patients demonstrated stable facial nerve function. Regarding facial numbness, 2 patients experienced increases, 8 no change, and 1 decreased numbness. There was no functional hearing prior to the second treatment in 10 patients, and hearing was impaired in 1 patient. Adverse radiation effects (slight peduncular edema) were seen in 2 patients after the second treatment, and 1 patient had edema after the first treatment as well. Conclusions Vestibular schwannomas can be retreated with GKS with good tumor control response and low risk of toxicity.

scholarly journals Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

2015 ◽  
Vol 123 (5) ◽  
pp. 1287-1293 ◽  
Author(s):  
Jason P. Sheehan ◽  
Cheng-Chia Lee ◽  
Zhiyuan Xu ◽  
Colin J. Przybylowski ◽  
Patrick D. Melmer ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
High Rate ◽  
Tumor Control ◽  
Peritumoral Edema ◽  
Who Grade ◽  
Increased Risk

OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

Long-term outcomes of patients with primary or residual vestibular schwannoma treated with LINAC-based stereotactic radiosurgery: a single-centre experience

2020 ◽  
pp. 1-7
Author(s):  
Patricia Sebastian ◽  
Subhashini John ◽  
Jebakarunya Reddy ◽  
Sunitha Susan Varghese ◽  
Harshad Arvind Vanjare ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Response To Treatment ◽  
Complication Rates ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumour Control ◽  
Prior Surgery ◽  
Facial Function

Abstract Aim: Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors. Materials and methods: A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS. Results: Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery. Findings: SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

Conservative Management or Gamma Knife Radiosurgery for Vestibular Schwannoma

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 48-57 ◽  
Author(s):  
Cathrine Nansdal Breivik ◽  
Roy Miodini Nilsen ◽  
Erling Myrseth ◽  
Paal Henning Pedersen ◽  
Jobin K. Varughese ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Conservative Management ◽  
Regression Models ◽  
Gamma Knife Radiosurgery ◽  
Rank Test ◽  
Tumor Growth Rate ◽  
Log Rank Test

Abstract BACKGROUND: There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). OBJECTIVE: The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development. METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models. RESULTS: Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P &lt; .001). Symptom and QoL development did not differ significantly between the groups. CONCLUSION: In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

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