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 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.

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.

Facial Nerve Preservation Surgery for Koos Grade 3 and 4 Vestibular Schwannomas

Neurosurgery ◽  
2014 ◽  
Vol 75 (6) ◽  
pp. 671-677 ◽  
Author(s):  
Amjad N. Anaizi ◽  
Eric A. Gantwerker ◽  
Myles L. Pensak ◽  
Philip V. Theodosopoulos
Keyword(s):  
Facial Nerve ◽  
Extent Of Resection ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Grade 3

Abstract Background: Facial nerve preservation surgery for large vestibular schwannomas is a novel strategy for maintaining normal nerve function by allowing residual tumor adherent to this nerve or root-entry zone. Objective: To report, in a retrospective study, outcomes for large Koos grade 3 and 4 vestibular schwannomas. Methods: After surgical treatment for vestibular schwannomas in 52 patients (2004–2013), outcomes included extent of resection, postoperative hearing, and facial nerve function. Extent of resection defined as gross total, near total, or subtotal were 7 (39%), 3 (17%), and 8 (44%) in 18 patients after retrosigmoid approaches, respectively, and 10 (29.5%), 9 (26.5%), and 15 (44%) for 34 patients after translabyrinthine approaches, respectively. Results: Hearing was preserved in 1 (20%) of 5 gross total, 0 of 2 near-total, and 1 (33%) of 3 subtotal resections. Good long-term facial nerve function (House-Brackmann grades of I and II) was achieved in 16 of 17 gross total (94%), 11 of 12 near-total (92%), and 21 of 23 subtotal (91%) resections. Long-term tumor control was 100% for gross total, 92% for near-total, and 83% for subtotal resections. Postoperative radiation therapy was delivered to 9 subtotal resection patients and 1 near-total resection patient. Follow-up averaged 33 months. Conclusion: Our findings support facial nerve preservation surgery in becoming the new standard for acoustic neuroma treatment. Maximizing resection and close postoperative radiographic follow-up enable early identification of tumors that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumor control rates.

scholarly journals Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach

Cureus ◽  
2018 ◽  
Author(s):  
Muhammad Shaheryar Ahmed Rajput ◽  
Ahmad Nawaz Ahmad ◽  
Asif Ali Arain ◽  
Mohammad Adeel ◽  
Saeed Akram ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function

“Large and giant vestibular schwannomas: overall outcomes and the factors influencing facial nerve function”

2020 ◽  
Author(s):  
Golda Grinblat ◽  
Manjunath Dandinarasaiah ◽  
Itzak Braverman ◽  
Abdelkader Taibah ◽  
Dario Giuseppe Lisma ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Factors Influencing

Middle Fossa Approach for Resection of Vestibular Schwannomas: A Decade of Experience

2018 ◽  
Vol 16 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Jennifer A Kosty ◽  
Shawn M Stevens ◽  
Yair M Gozal ◽  
Vincent A DiNapoli ◽  
Smruti K Patel ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Pure Tone ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Pure Tone Average ◽  
Class A ◽  
The Mean

AbstractBACKGROUNDThe middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP).OBJECTIVETo describe a decade-long, single institutional experience with the MCF approach for resection of VS.METHODSThis is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House–Brackmann scale.RESULTSThe mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation.CONCLUSIONIn our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.

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