Trigeminal schwannomas: results of Gamma Knife surgery in 37 cases

2007 ◽  
Vol 106 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Yoshihisa Kida ◽  
Masayuki Yoshimoto ◽  
Jouji Koike
Keyword(s):  
Gamma Knife ◽  
Functional Outcomes ◽  
Neurofibromatosis Type ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
City Hospital ◽  
Select Group ◽  
The Mean ◽  
Good Tumor Control ◽  
Tumor Remission

Object Information on outcomes of Gamma Knife surgery (GKS) for patients harboring trigeminal schwannomas is limited because these tumors are rare. The authors evaluated tumor control and functional outcomes in patients who underwent GKS for trigeminal schwannomas to clarify the efficacy of this treatment. Methods Forty-two patients with trigeminal schwannomas but no evidence of neurofibromatosis Type 2 were treated with GKS at Komaki City Hospital between November 1991 and December 2003. Of these, 37 patients were assessed. The mean tumor volume in these patients was 10 cm3. The mean maximum radiation dose directed to the tumor was 27.9 Gy and the mean dose directed to the tumor margin was 14.2 Gy. The mean follow-up period was 54 months. In four patients (11%) there was complete tumor remission; in 20 (54%) there was partial tumor remission; in eight (22%) the disease remained stable; and in five (14%) the tumor enlarged or uncontrollable facial pain developed with radiation-induced edema requiring resection. The actuarial 5- and 10-year tumor control rates were both 84%. With respect to functional outcomes, 40% of patients noted an improvement in their symptoms, and one patient experienced new symptoms despite good tumor control. Conclusions Gamma Knife surgery was a safe and effective treatment for a select group of patients harboring trigeminal schwannomas. Large tumors that compress the brainstem and cause deviation of the fourth ventricle should first be removed surgically and any remnant should be treated by GKS.

scholarly journals Gamma Knife surgery for facial nerve schwannomas

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 116-122 ◽  
Author(s):  
Ju Hyung Moon ◽  
Won Seok Chang ◽  
Hyun Ho Jung ◽  
Kyu Sung Lee ◽  
Yong Gou Park ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Functional Outcomes ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
The Mean ◽  
Clinical Records ◽  
Facial Nerve Schwannoma

ObjectThe aim of this study was to evaluate the tumor control rate and functional outcomes after Gamma Knife surgery (GKS) among patients with a facial nerve schwannoma.MethodsThe authors reviewed the radiological data and clinical records for 14 patients who had consecutively undergone GKS for a facial nerve schwannoma. Before GKS, 12 patients had facial palsy, 7 patients had hearing disturbance, and 5 patients had undergone partial or subtotal tumor resection. The mean and median tumor volumes were 3707 mm3 and 3000 mm3, respectively (range 117–10,100 mm3). The mean tumor margin dose was 13.2 Gy (range 12–15 Gy), and the mean maximum tumor dose was 26.4 Gy (range 24–30 Gy). The mean follow-up period was 80.7 months (range 2–170 months).ResultsControl of tumor growth was achieved in all 12 (100%) patients who were followed up for longer than 2 years. After GKS, facial nerve function improved in 2 patients, remained unchanged in 9 patients, and worsened in 3 patients. All patients who had had serviceable hearing at the preliminary examination maintained their hearing at a useful level after GKS. Other than mild tinnitus reported by 3 patients, no other major complications developed.ConclusionsGKS for facial nerve schwannomas resulted in excellent tumor control rates and functional outcomes. GKS might be a good primary treatment option for patients with a small- to medium-sized facial nerve schwannoma when facial nerve function and hearing are relatively preserved.

Gamma Knife surgery for invasive pituitary macroadenoma

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 26-30 ◽  
Author(s):  
Mooseong Kim ◽  
Sunghwa Paeng ◽  
Seyoung Pyo ◽  
Yeonggyun Jeong ◽  
Sunil Lee ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Pituitary Macroadenoma ◽  
Female Ratio ◽  
Fractionated Radiotherapy ◽  
The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

scholarly journals Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 17-22 ◽  
Author(s):  
Fumi Higuchi ◽  
Shunsuke Kawamoto ◽  
Yoshihiro Abe ◽  
Phyo Kim ◽  
Keisuke Ueki
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Efficient Treatment ◽  
Stereotactic Aspiration ◽  
Stereotactic Frame ◽  
Cystic Component ◽  
Tumor Volume Reduction ◽  
Good Tumor Control

Object Gamma Knife surgery (GKS) has gained increasing relevance in the treatment of metastatic brain tumors, but many metastatic tumors contain a large cystic component and often exceed the size limit for GKS. For such lesions, the authors adopted a procedure in which stereotactic aspiration is first performed and followed immediately by GKS on the same day. In this paper, the authors describe this 1-day combined procedure and evaluate its efficacy. Methods Between 2005 and 2010, 25 cystic metastases in 25 patients were treated at Dokkyo Medical University. The patients first underwent MRI and stereotactic aspiration of the cyst while stationary in a Leksell stereotactic frame; immediately afterward, the patients underwent a second MR imaging session and Gamma Knife treatment. Tumor volume reduction, tumor control rate, and overall survival were examined. Results Tumor volume, including the cystic component, decreased from 8.0–64.2 cm3 (mean 20.3 cm3) to 3.0–36.2 cm3 (mean 10.3 cm3) following aspiration, and the volume of 24 of 25 lesions decreased to less than 16.6 cm3, which is equivalent to the volume of a 3.16-cm sphere. At least 20 Gy was delivered to the entire lesion in 24 of 25 cases. Good tumor control was obtained in 16 of 21 cases that could be evaluated during a median follow-up period of 11 months (range 1–27 months); however, reaccumulation of cyst contents was observed in 2 patients who required Ommaya reservoir placement. Conclusions The 1-day aspiration plus GKS procedure is an effective and time-efficient treatment for large cystic brain metastases.

Volumetric follow up of brain metastases: a useful method to evaluate treatment outcome and predict survival after Gamma Knife surgery?

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 91-98 ◽  
Author(s):  
Guenther Christian Feigl ◽  
Gerhard A. Horstmann
Keyword(s):  
Treatment Outcome ◽  
Side Effects ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Tumor Type ◽  
The Mean

ObjectBrain metastases are diagnosed in 20 to 40% of all cancer patients and are associated with a considerable drop in life expectancy and often also in quality of life for these patients. Several treatment options are available including surgery, chemotherapy, whole-brain radiotherapy, stereotactic radiotherapy, stereotactic radiosurgery, and Gamma Knife surgery (GKS). However, management of brain metastases still presents a challenge and there is no general consensus on the best treatment strategy. The aim of the authors' study was to further evaluate the efficacy of GKS in the treatment of brain metastases and to evaluate the predictive value of volumetric tumor follow-up measurement.MethodsConsecutive patients with controlled systemic cancer and variable numbers of brain metastases were included in this prospective study. Patients with severe symptoms of brain compression underwent surgery before GKS. Each follow-up examination included a thorough neurological examination and a neuroradiological quantitative volumetric tumor analysis.A total of 300 consecutive patients (mean age 58 years) with 703 brain metastases were treated between December 1998 and October 2005. The mean total tumor volume (TTV) was 2.1 cm3. The overall local tumor control rate was 84.5%. In 79% of all treated metastases a mean TTV reduction of 84.7% was achieved using a mean prescription dose of 21.8 Gy. Only few, mostly mild, side effects were observed during the mean follow-up period of 12.7 months. The overall mean progression-free survival period was 9.4 months. There was a statistically significant difference in survival of patients with one compared with multiple metastases, regardless of the histological type and preceding treatment.Conclusions Gamma Knife surgery is a safe and effective treatment for patients with brain metastases regardless of the history of treatment and histological tumor type. It achieves excellent tumor control, significant TTV reduction without causing severe side effects, and accordingly, preserves quality of live. Volume changes after GKS did not serve as a predictor for treatment outcome and survival.

Gamma knife surgery for multiple hemangioblastomas

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 97-101 ◽  
Author(s):  
Yong Sook Park ◽  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Sang Sup Chung ◽  
Yong Gou Park
Keyword(s):  
Gamma Knife ◽  
Small Diameter ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Posterior Fossa Decompression ◽  
Shunt Insertion ◽  
Content Type ◽  
Multiple Lesions ◽  
The Mean ◽  
Fine Print

Object. The authors describe their experience in treating patients with hemangioblastoma, especially multiple lesions, with gamma knife surgery (GKS). Methods.Nine patients with 84 hemangioblastomas underwent GKS between July 1992 and May 2003. Three patients harbored a single lesion and six patients had multiple lesions. Of the six patients with multifocal tumors, a diagnosis of von Hippel—Lindau disease had been established in five. In the patients with multiple lesions, the mean radiation dose delivered to the tumor margin was 16.6 Gy (range 12.8–29.75 Gy). The mean margin isodose was 60% (range 40–95%). Three of the 84 lesions failed to be controlled after a mean follow-up period of 4.3 years (range 8.6–141 months). One patient who had undergone two GKS treatments suffered delayed radiation-induced complications, and posterior fossa decompression and ventriculoperitoneal shunt insertion were required. Conclusions. To achieve tumor control and avoid morbidity, the surgeon should keep in mind minimizing field overlapping by using a small-diameter collimator or applying a steep dose gradient, and by accurate dose prescription.

Volume reduction in meningiomas after gamma knife surgery

2005 ◽  
Vol 102 ◽  
pp. 189-194 ◽  
Author(s):  
Guenther C. Feigl ◽  
Otto Bundschuh ◽  
Alireza Gharabaghi ◽  
Madjid Samii ◽  
Gerhard A. Horstmann
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Volume Reduction ◽  
World Health ◽  
Tumor Control ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object.The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment.Methods.A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter.The mean tumor volume was 5.9 cm3(range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase.Conclusions.Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.

Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma

2007 ◽  
Vol 107 (4) ◽  
pp. 745-751 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Yoshihisa Kida ◽  
Masayuki Yoshimoto ◽  
Joji Koike ◽  
Hiroshi Iizuka ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Initial Treatment ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
The Mean

Object The aim of this study was to evaluate long-term outcomes, including tumor control and neurological function, in patients with cavernous sinus meningiomas treated using Gamma Knife surgery (GKS). Methods One hundred fifteen patients with cavernous sinus meningiomas, excluding atypical or malignant meningiomas, were treated with GKS between 1991 and 2003. Forty-nine patients (43%) underwent GKS as the initial treatment. The mean tumor volume was 14 cm3, and the mean maximum and margin doses applied to the tumor were 27 and 13 Gy, respectively. The median follow-up period was 62 months. During the follow-up, 111 patients were able to be evaluated with neuroimaging. Results The actuarial 5- and 10-year progression-free survival rates were 87 and 73%, respectively. Similarly, the actuarial 5- and 10-year focal tumor control rates were 94 and 92%, respectively. Regarding functional outcomes, 43 patients (46%) experienced some degree of improvement, 40 (43%) remained stable, and 11 (12%) had worse preexisting or newly developed symptoms. Patients who underwent GKS as the initial treatment experienced significant improvement of their symptoms (p = 0.006). Conclusions Gamma Knife surgery is a safe and effective treatment over the long term in selected patients with cavernous sinus meningiomas. Tumor progression is more likely to occur from the lesion margin outside the treatment volume. In small to medium-sized tumors, GKS is an excellent alternative to resection, preserving good neurological function. For relatively large-sized tumors, low-dose radiosurgery (≤ 12 Gy) is acceptable for the prevention of tumor progression.

Gamma Knife surgery for skull base chordomas and chondrosarcomas

2007 ◽  
Vol 107 (4) ◽  
pp. 752-757 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Dai Ishii ◽  
Yoshihisa Kida ◽  
Masayuki Yoshimoto ◽  
Joji Koike ◽  
...  
Keyword(s):  
Skull Base ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Gamma Knife Surgery ◽  
High Rate ◽  
Tumor Control ◽  
Low Grade ◽  
The Mean ◽  
Skull Base Chordomas

Object The purpose of this study was to evaluate radiosurgical outcomes in skull base chordomas and chondrosarcomas, and to determine which tumors are appropriate for stereotactic radiosurgery as adjuvant therapy following maximum tumor resection. Methods Thirty-seven patients (48 lesions) were treated using Gamma Knife surgery (GKS); 27 had chordomas, seven had chondrosarcomas, and three had radiologically diagnosed chordomas. The mean tumor volume was 20 ml, and the mean maximum and marginal doses were 28 and 14 Gy, respectively. The mean follow-up period was 97 months from diagnosis and 59 months from GKS. Results The actuarial 5- and 10-year survival rates after GKS were 80 and 53%, respectively. The actuarial 5- and 10-year local tumor control (LTC) rates after single or multiple GKS sessions were 76 and 67%, respectively. All patients with low-grade chondrosarcomas achieved good LTC. A tumor volume of less than 20 ml significantly affected the high rate of LTC (p = 0.0182). No patient had adverse radiation effects, other than one in whom facial numbness worsened despite successful tumor control. Conclusions As an adjuvant treatment after resection, GKS is a reasonable option for selected patients harboring skull base chordomas or chondrosarcomas with a residual tumor volume of less than 20 ml. Dose planning with a generous treatment volume to avoid marginal treatment failure should be made at a marginal dose of at least 15 Gy to achieve long-term tumor control.

scholarly journals Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan

2016 ◽  
Vol 125 (4) ◽  
pp. 822-831 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Takenori Kato ◽  
Yoshihisa Kida ◽  
Ayaka Sasaki ◽  
Yoshiyasu Iwai ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Radiation Effects ◽  
Progression Free Survival ◽  
Jugular Foramen ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Lower Cranial Nerve ◽  
Good Tumor Control

OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm3, and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3-fraction schedule. RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively. CONCLUSIONS GKS resulted in good tumor control in patients with either primary or residual JFSs. Although some patients experienced some degree of symptomatic deterioration after treatment, persistent adverse radiation effects were seen in only 3% of the entire series at the last follow-up. Lower cranial nerve deficits were extremely rare adverse radiation effects, and preexisting hoarseness and swallowing disturbances improved in two-thirds of patients. These results indicated that GKS was a safe and reasonable alternative to surgical resection in selected patients with JFSs.

Volume reduction in meningiomas after gamma knife surgery

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 189-194 ◽  
Author(s):  
Guenther C. Feigl ◽  
Otto Bundschuh ◽  
Alireza Gharabaghi ◽  
Madjid Samii ◽  
Gerhard A. Horstmann
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Surgery ◽  
Volume Reduction ◽  
World Health ◽  
Tumor Control ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment. Methods. A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter. The mean tumor volume was 5.9 cm3 (range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase. Conclusions. Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.

Sign in / Sign up

Export Citation Format

Share Document