Gamma Knife surgery for trigeminal schwannoma

2007 ◽  
Vol 106 (5) ◽  
pp. 839-845 ◽  
Author(s):  
Jason Sheehan ◽  
Chun Po Yen ◽  
Yasser Arkha ◽  
David Schlesinger ◽  
Ladislau Steiner
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
University Of Virginia ◽  
Trigeminal Schwannoma ◽  
The Mean ◽  
The University ◽  
Lost To Follow Up

Object Trigeminal schwannomas are rare intracranial tumors. In the past, resection and radiation therapy were the mainstays of their treatment. More recently, neurosurgeons have begun to use radiosurgery in the treatment of trigeminal schwannomas because of its successful use in the treatment of vestibular schwannomas. In this article the authors evaluate the radiological and clinical outcomes in a series of patients in whom Gamma Knife surgery (GKS) was used to treat trigeminal schwannomas. Methods Twenty-six patients with trigeminal schwannomas underwent GKS at the University of Virginia Lars Lek-sell Gamma Knife Center between 1989 and 2005. Five of these patients had neurofibromatosis and one patient was lost to follow up. The median tumor volume was 3.96 cm3, and the mean follow-up period was 48.5 months. The median prescription radiation dose was 15 Gy, and the median prescription isodose configuration was 50%. There was clinical improvement in 18 patients (72%), a stable lesion in four patients (16%), and worsening of the disease in three patients (12%). On imaging, the schwannomas shrank in 12 patients (48%), remained stable in 10 patients (40%), and increased in size in three patients (12%). These results were comparable for primary and adjuvant GKSs. No tumor growth following GKS was observed in the patients with neurofibromatosis. Conclusions Gamma Knife surgery affords a favorable risk-to-benefit profile for patients harboring trigeminal schwannomas. Larger studies with open-ended follow-up review will be necessary to determine the long-term results and complications of GKS in the treatment of trigeminal schwannomas.

Gamma Knife thalamotomy for treatment of essential tremor: long-term results

2010 ◽  
Vol 112 (6) ◽  
pp. 1311-1317 ◽  
Author(s):  
Ronald F. Young ◽  
Francisco Li ◽  
Sandra Vermeulen ◽  
Robert Meier
Keyword(s):  
Surgical Treatment ◽  
Essential Tremor ◽  
Gamma Knife ◽  
Surgical Intervention ◽  
Long Term Results ◽  
The Mean ◽  
Lost To Follow Up ◽  
Deep Brain

Object The goal of this report was to describe the safety and effectiveness of nucleus ventralis intermedius (VIM) thalamotomy performed with the Leksell Gamma Knife (GK) for the treatment of essential tremor (ET). Methods One hundred seventy-two patients underwent a total of 214 VIM thalamotomy procedures with the Leksell GK between February 1994 and March 2007 for treatment of disabling ET. Eleven patients were lost to follow-up less than 1 year after the procedures, so that in this report the authors describe the results in 161 patients who underwent a total of 203 thalamotomies (119 unilateral and 42 bilateral). Results There were statistically significant decreases (p < 0.0001) in tremor scores for both writing and drawing. The mean postoperative follow-up duration for all patients was 44 ± 33 months. Fifty-four patients have been followed for more than 60 months posttreatment. There were 14 patients who suffered neurological side effects that were temporary (6) or permanent (8), which accounted for 6.9% of the 203 treatments. All complications were related to lesions that grew larger than expected. Conclusions A VIM thalamotomy with the Leksell GK offers a safe and effective alternative for surgical treatment of ET. It is particularly applicable to patients who are not ideal candidates for deep brain stimulation but can be offered to all patients who are considering surgical intervention for ET.

Long-term results of Gamma Knife surgery for optic nerve sheath meningioma

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 28-33 ◽  
Author(s):  
Dong Liu ◽  
Desheng Xu ◽  
Zhiyuan Zhang ◽  
Yipei Zhang ◽  
Yanhe Li ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Optic Nerve Sheath ◽  
Long Term Results ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
The Mean

Object The goal of this study was to assess the long-term results of Gamma Knife surgery (GKS) in patients harboring an optic nerve sheath meningioma (ONSM). Methods Thirty patients harboring an ONSM were treated with GKS between 1998 and 2003. Gamma Knife surgery was performed as the sole treatment option in 21 of these patients and resection had been performed previously in 9 patients. The mean volume of the tumor at the time of GKS was 3.6 cm3 (range 1.4–9.7 cm3), and the mean prescription peripheral dose was 13.3 Gy (range 10–17 Gy). The mean number of isocenters used to treat these lesions was 8 (range 5–14 isocenters). Results At a median follow-up of 56 months, visual acuity improved in 11 patients, remained stable in 13 patients (including 4 patients who were completely blind before GKS), and deteriorated in 6 patients. Follow-up images were available in all patients and showed tumor regression in 20 patients and stable tumor in 8 patients. Persistent imaging evidence of progression was only present in 2 patients. With the exception of reversible conjunctival edema in 4 cases, no other serious acute side effect was observed. Conclusions Gamma Knife surgery provides long-term tumor control for ONSM. The results of this study add substantial evidence that GKS may definitely become a standard treatment approach in selected cases of ONSM.

P14.67 Long-term results of gamma knife radiosurgery for treatment of intracranial glomus jugulare tumors

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii50-ii51
Author(s):  
R M Emad Eldin ◽  
K M Abdel Karim ◽  
A M N El-Shehaby ◽  
W A Reda ◽  
A M Nabeel ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Long Term Results ◽  
Glomus Jugulare ◽  
The Mean ◽  
Mean Time

Abstract BACKGROUND Glomus Jugulare tumors are benign but locally aggressive ones that represent a therapeutic challenge. Previous studies about the use of Gamma Knife Radiosurgery (GRS) in those tumors have documented good results that needed larger number of patients and longer follow up periods to be confirmed. MATERIAL AND METHODS Between August 2001 and December 2017, 70 patients with glomus jugulare tumors were treated at the Gamma Knife Center, Cairo. They were 46 females and 24 males. The mean age was 48 years (16–71 years). Nineteen of these patients were previously operated, 5 were partially embolized, 3 underwent embolization and subsequent surgery and 43 had gamma knife as their primary treatment. Volume-staged gamma knife radiosurgery was used in 10 patients and single-session in 60 patients, with a total of 86 sessions. The mean target volume was 12.7 cm3 (range 0.2 to 34.5 cm3). The mean tumor volume was 15.5 cm3 (range 0.2 to 105 cm3). The mean prescription dose was 14.5 Gy (range 12 to 18 Gy). RESULTS The mean follow up period was 60 months (range 18 to 206 months), and by the time of the data analysis, two of the patients were dead (66 and 24 months after GK treatment). The tumor control was 98.6% (69/70). Thirty-two tumors became smaller and 37 were unchanged. The symptoms improved in 36 patients, were stable in 32 patients, and worsened in 2 patients who developed a transient facial palsy and worsened hearing. Symptomatic improvement began before any reduction in tumor volume could be detected, where the mean time to clinical improvement was 7 months whereas the mean time to tumor shrinkage was 18 months. CONCLUSION This study about the long term follow up of the GKR for the intracranial glomus jugulare tumors confirmed that this is a highly effective and safe treatment. This data shows that the clinical improvement is not correlated with the radiological volume reduction.

Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 119-123 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Yoshimasa Mori ◽  
Yukio Uchiyama ◽  
Yoshihisa Kida ◽  
Shigeru Fujitani
Keyword(s):  
Growth Hormone ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Content Type ◽  
The Mean ◽  
Dose Radiation ◽  
Fine Print

Object. The authors conducted a study to determine the long-term results of gamma knife surgery for residual or recurrent growth hormine (GH)—producing pituitary adenomas and to compare the results with those after treatment of other pituitary adenomas. Methods. The series consisted of 67 patients. The mean tumor diameter was 19.2 mm and volume was 5.4 cm3. The mean maximum dose was 35.3 Gy and the mean margin dose was 18.9 Gy. The mean follow-up duration was 63.3 months (range 13–142 months). The tumor resolution rate was 2%, the response rate 68.3%, and the control rate 100%. Growth hormone normalization (GH < 1.0 ng/ml) was found in 4.8%, nearly normal (< 2.0 ng/ml) in 11.9%, significantly decreased (< 5.0 ng/ml) in 23.8%, decreased in 21.4%, unchanged in 21.4%, and increased in 16.7%. Serum insulin-like growth factor (IGF)—1 was significantly decreased (IGF-1 < 400 ng/ml) in 40.7%, decreased in 29.6%, unchanged in 18.5%, and increased in 11.1%, which was almost parallel to the GH changes. Conclusions. Gamma knife surgery was effective and safe for the control of tumors; however, normalization of GH and IGF-1 secretion was difficult to achieve in cases with large tumors and low-dose radiation. Gamma knife radiosurgery is thus indicated for small tumors after surgery or medication therapy when a relatively high-dose radiation is required.

Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up

2005 ◽  
Vol 102 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Yoshihisa Kida ◽  
Tatsuya Kobayashi ◽  
Masayuki Yoshimoto ◽  
Yoshimasa Mori ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Long Term Outcomes ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Gamma knife surgery (GKS) has been a safe and effective treatment for vestibular schwannomas in both the short and long term, although less is known about long-term outcomes in the past 10 years. The aim of this study was to clarify long-term outcomes in patients with vestibular schwannomas treated using GKS based on techniques in place in the early 1990s. Methods. Eighty patients harboring a vestibular schwannoma (excluding neurofibromatosis Type 2) were treated using GKS between May 1991 and December 1993. Among these, 73 patients were assessed; seven were lost to follow up. The median duration of follow up was 135 months. The mean patient age at the time of GKS was 56 years old. The mean tumor volume was 6.3 cm3, and the mean maximal and marginal radiation doses applied to the tumor were 28.4 and 14.6 Gy, respectively. Follow-up magnetic resonance images were obtained in 71 patients. Forty-eight patients demonstrated partial tumor remission, 14 had tumors that remained stable, and nine demonstrated tumor enlargement or radiation-induced edema requiring resection. Patients with larger tumors did not fare as well as those with smaller lesions. The actuarial 10-year progression-free survival rate was 87% overall, and 93% in patients with tumor volumes less than 10 cm3. No patient experienced malignant transformation. Conclusions. Gamma knife surgery remained an effective treatment for vestibular schwannomas for longer than 10 years. Although treatment failures usually occurred within 3 years after GKS, it is necessary to continue follow up in patients to reveal delayed tumor recurrence.

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.

Long-term results of Gamma Knife surgery for arteriovenous malformations: 10- to 15-year follow up in patients treated with lower doses

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 64-68 ◽  
Author(s):  
Hiroshi K. Inoue
Keyword(s):  
Adverse Effects ◽  
Brain Edema ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Cyst Formation ◽  
Gamma Knife Surgery ◽  
Surrounding Tissue ◽  
Long Term Results

ObjectSeveral adverse effects such as brain edema, necrosis, arterial stenosis, hemorrhage after obliteration, and delayed cyst formation have been reported as early and late complications of Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs). These adverse effects seem to be decreased in a lower-dose treatment regimen compared with the classic higher margin doses of 25 Gy because the radiation insult to the surrounding tissue is minimized. Long-term results of lower-dose GKS for AVMs are presented.MethodsOne hundred fourteen patients with AVMs were treated with lower-dose GKS (≤ 20-Gy margin dose). There were 68 male and 46 female patients, aged 10 to 68 years (mean 35.4 years). The evaluation of AVM nidi and dose planning were performed using both angiography and MR imaging in all cases to exclude the surrounding brain tissue. The mean margin dose was 19.5 Gy.Total angiographically documented obliteration was achieved in 65 (85.5%) of 76 patients. Eleven patients underwent a second treatment, including staged treatment for large AVMs; total AVM obliteration has been achieved in six of them to date. Of 38 patients in whom no follow-up examination could be performed, 19 of them were healthy and 10 were lost from follow up. Nine patients experienced bleeding during the latency period, and four of them suffered lethal hemorrhage. Symptomatic early complications were extensive brain edema after repeated GKS in one patient and an adverse effect on the internal capsule in one. Delayed cyst formation was found in one patient as a late complication 10 years after treatment. No treatment-related death has been noted to date.Conclusions Lower-dose GKS is an effective and safe treatment for patients with AVMs and may decrease long-term adverse effects to the surrounding brain.

Long-term outcomes after Gamma Knife surgery for vestibular schwannomas: a 10-year experience

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 149-153 ◽  
Author(s):  
Dong Liu ◽  
Desheng Xu ◽  
Zhiyuan Zhang ◽  
Yipei Zhang ◽  
Ligao Zheng
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Hearing Improvement ◽  
Long Term Outcomes ◽  
Peripheral Dose ◽  
Function Preservation ◽  
The Mean

ObjectThe authors sought to assess the results of Gamma Knife surgery (GKS) in patients with vestibular schwannomas (VSs).MethodsSeventy-four consecutive patients (33 men and 41 women) were evaluated by means of serial imaging studies, clinical examinations, and questionnaires. Nineteen patients had undergone resection of their VS. Facial nerve function was normal in 63 patients (85.1%) before GKS, and 63.5% of them had useful hearing. The prescription peripheral dose varied between 10 and 14 Gy (mean 12.27 ± 0.96 Gy); the corresponding central dose was 21 to 30 Gy (mean 24.9 ± 2.18 Gy). The mean volume of the tumor at GKS was 10.79 ± 5.52 ml (range 0.11–27.8 ml). A mean of eight isocenters (range 3–17) was used for treating these lesions.At a median follow-up period of 68.3 months (range 30–122 months), tumor shrinkage was observed in 60 patients (81.1%), and the tumor size was stable in 11 (14.8%). Persistent neuroimaging demonstrated evidence of progression in only three patients (4.1%): two underwent repeated GKS after an interval of 18 months and one continues to be observed. Five patients experienced trigeminal dysfunction: in three the dysfunction was transient and in the other two the dysfunction persists. Three patients suffered facial palsy. Useful hearing was preserved in 34 patients. Thirteen patients experienced some degree of hearing improvement. Deterioration of hearing was found in 13 of 62 patients who had Class I or II hearing before treatment.Conclusions Gamma Knife surgery prevents tumor growth; it achieves excellent neurological function preservation and produces few treatment-related complications.

Long-term Results of Gamma Knife Surgery for Partially Embolized Arteriovenous Malformations

Neurosurgery ◽  
2012 ◽  
Vol 71 (6) ◽  
pp. 1139-1148 ◽  
Author(s):  
Lucia Schwyzer ◽  
Chun-Po Yen ◽  
Avery Evans ◽  
Sebastian Zavoian ◽  
Ladislau Steiner
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Combined Treatment ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Historical Series ◽  
Radiation Induced ◽  
The Mean ◽  
Induced Changes

ABSTRACT BACKGROUND: The effectiveness and risk of Gamma Knife surgery (GKS) in the management of partially embolized cerebral arteriovenous malformations (AVMs) remain to be elucidated. OBJECTIVE: To evaluate the long-term imaging and clinical outcomes of GKS in AVM patients who had undergone previous partial embolization and compare the results with patients treated with GKS alone. METHODS: A total of 215 embolized AVMs were analyzed. The mean patient age was 32.9 years. The mean volume of the nidus was 4.6 mL (range, 0.1-29.4 mL), and the mean prescription dose was 19.6 Gy (range, 4-28 Gy). This group was compared with 729 nonembolized AVMs. RESULTS: After embolization and GKS, angiographically confirmed total obliteration of the AVMs was significantly lower (33%) compared with patients in whom GKS was used alone (60.9%; P &lt; .001). However, the mean nidus size was larger and the Spetzler-Martin grade was higher for the embolized AVMs compared with the nonembolized AVMs. Radiation-induced changes occurred more often in the embolized (43.4%) than the nonembolized (33.4%) AVMs (P = .028). Permanent neurological deficits associated with radiation-induced changes occurred in 2.7% of the embolized compared with 1.3% of the nonembolized patients (P = .14). CONCLUSION: In our retrospective and historical series, the long-term results suggest that the obliteration rate is significantly lower in embolized AVMs compared with nonembolized AVMs, also because of the fact that the combined treatment is applied to higher grade AVMs; the percentage of grade III-V AVMs was 58.6% and 48.8% for nonembolized AVMs.

Long-term results of Leksell gamma knife surgery for trigeminal schwannomas

2005 ◽  
Vol 102 ◽  
pp. 220-224 ◽  
Author(s):  
Li Pan ◽  
En-Min Wang ◽  
Nan Zhang ◽  
Liang-Fu Zhou ◽  
Bing-Jiang Wang ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Growth Control ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Long Term Results ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The authors evaluated the long-term efficacy of gamma knife surgery (GKS) in patients with trigeminal schwannomas. Methods. Fifty-six patients, 31 women and 25 men (mean age 42 years), underwent GKS for trigeminal schwannomas. Fourteen had previously undergone surgery, and GKS was the primary treatment in the remaining 42 patients. The mean target volume was 8.7 cm3 (range 0.8–33 cm3); the mean maximum dose was 27 Gy (range 20–40 Gy); the mean tumor margin dose was 13.3 Gy (range 10–15 Gy); and the mean follow-up period was 68 months (range 27–114 months). Disappearance of the tumor occurred in seven patients. An obvious decrease in tumor volume was observed in 41 patients, four tumors remained unchanged, and four tumors progressed at 5, 26, 30, and 60 months, respectively. One patient with disease progression died of tumor progression at 36 months after GKS. The tumor growth control rate in this group was 93% (52 of 56 cases). Mild numbness or diplopia was relieved completely in 14 patients. Improvement of other neurological deficits was demonstrated in 25 patients. Trigeminal nerve dysfunction was either unchanged or slightly worse in 13 patients after GKS. Four patients experienced mild symptom deterioration related to tumor progression. Conclusions. Radiosurgery proved to be an effective treatment for small- and medium-sized trigeminal schwannomas. Some larger tumors are also suitable for radiosurgery if there is no significant brainstem compression.

Sign in / Sign up

Export Citation Format

Share Document