Gamma Knife Stereotactic Radiosurgery for Nonvestibular Cranial Nerve Schwannomas

Langlois, Anne-Marie; Iorio-Morin, Christian; Masson-Côté, Laurence; Mathieu, David

doi:10.1016/j.wneu.2017.11.163

Cited by 19 publications

(5 citation statements)

References 24 publications

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“…1,6,8-41 In addition, 13 studies were included in the systematic review for the SRS cohort series (Table 6). 42-54 In the surgical cohort, females comprised 55% of the primary surgical cohort. Nearly half of the tumors had extracranial extension (46%) although the incidence was highly variable between studies (range 0%-100%).…”

Section: Resultsmentioning

confidence: 99%

Lower Cranial Nerve Schwannomas: Cohort Study and Systematic Review

Carlstrom,

Bauman,

Oushy

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Schwannomas originating from the lower cranial nerves (LCNS) are rare and pose a significant surgical challenge. Resection is the mainstay treatment; however, risk of treatment morbidity is considerable, and the available literature regarding differential treatment outcomes in this vulnerable population is sparse. METHODS: A single-institution cohort study and systematic literature review of LCNS were performed. RESULTS: Fifty-eight patients were included: 34 underwent surgical resection and 24 underwent stereotactic radiosurgery (SRS). The median age at diagnosis was 48 years (range 17-74). Presenting symptoms were dysphagia (63%), dysarthria/hypophonia (47%), imbalance (33%), and hearing loss/tinnitus (30%). Tumor size was associated with surgical resection, as compared with initial SRS (4.1 cm vs 1.5 cm, P = .0001). Gross total resection was obtained in 52%, with tumor remnants predominantly localized to the jugular foramen (62%). Post-treatment worsening of symptoms occurred in 68% of surgical and 29% of SRS patients (P = .003). Postoperative symptoms were mostly commonly hypophonia/hoarseness (63%) and dysphagia (59%). Seven patients (29%) had new neurological issues after SRS treatment, but symptoms were overall milder. The median follow-up was 60 months (range 12-252); 98% demonstrated meaningful clinical improvement. Eighteen surgical patients (53%) underwent adjuvant radiation at a median of 5 months after resection (range 2-32). At follow-up, tumor control was 97% in the surgical cohort and 96% among SRS patients. CONCLUSION: Although LCNS resection is potentially morbid, most postoperative deficits are transient, and patients achieve excellent tumor control—particularly when paired with adjuvant SRS. For minimally symptomatic patients undergoing surgical intervention, we advise maximally safe resection with intracapsular dissection to preserve nerve integrity where possible. For residual or as a primary treatment modality, SRS is associated with low morbidity and high rates of long-term tumor control.

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Section: Resultsmentioning

confidence: 99%

Lower Cranial Nerve Schwannomas: Cohort Study and Systematic Review

Carlstrom,

Bauman,

Oushy

et al. 2023

Neurosurgery

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“…The comparison of the treatment result of our study population to the past studies is summarized in Table 5. [11,14,17,3,1,13,2,15,4,12,7,5,6,16] Except for spinal schwannomas, we still have few long-term data on nVS treated by SRT. 3).…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Outcome of CyberKnife-Based Stereotactic Radiotherapy for Intra/ Extracranial Non-Vestibular Schwannomas: A Single-Center Experience

Hong

Kagawa

Sato

et al. 2022

Preprint

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The long-term outcomes of CyberKnife-based hypofractionated stereotactic radiotherapy (SRT) for intra/ extracranial non-vestibular schwannomas (nVS) need to be accumulated. Patients who received SRT by CyberKnife for nVS from 2010 to 2019 were retrospectively reviewed. A total of 45 patients with nVS were identified. The mean age was 53 (± 18) years old, and 23 patients (51%) were female. Twenty-nine patients (64%) had previous procedures. As for the tumor extension, 22 (49%) nVS were classified as primary intracranial, five (11%) were classified as intra/ extracranial (dumbbell shape), and 18 (40%) were classified as primary extracranial. The median prescribed dose, covering 95% of the planning target volume, was 21 (IQR 21 – 25) Gy, and the median target volume was 7 (IQR 3.6-13.1) cm3. The local control rate of nVS for patients without neurofibromatosis type 2 (NF2) was 100%. Old age (OR 0.92, p-value 0.03) and previous surgery (OR 0.02, p-value 0.02) were significant risk factors for no symptomatic improvement. The progression-free survival was 74 (±33) months clinically and 69 (IQR 36 – 94) months radiologically. During follow-up, two cases (4%) with NF2 resulted in treatment failure, 13 cases (41%) resulted in transient tumor expansion (TTE), 10 (22%) suffered from transient adverse radiation effect (ARE), and two (4%) resulted in permanent ARE. Hypofractionated SRT by CyberKnife for head, neck, and spine nVS was an effective treatment regardless of tumor extension relative to the cranium. Although the risk of permanent ARE was low, some patients experienced transient clinical worsening due to TTE.

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“…Radiosurgery is becoming a non-invasive alternative for most CPA tumors, such as schwanomas and meningiomas smaller than 2cm [25,27,28,32,33]. Not having this technique in Senegal, no patient has had radiosurgery in our series.…”

Section: Therapeutic Aspectsmentioning

confidence: 95%

Management of Tumors of the Cerebellopontine Angle in Developing Countries: Experience of Fann Teaching Hospital in Dakar

Mbaye¹

2019

TNN

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Introduction: Cerebellopontine angle (CPA) tumors account for about 5 to 10% of intracranial tumors in the literature. The majority of lesions in this region are benign, so surgery is the main treatment. The literature on the management of these lesions is poor in our context. In this way, we will draw up the epidemiological profile and analyze the diagnostic, therapeutic and evolutionary aspects of this pathology in Dakar. Materials and methods:This is a retrospective study of 51 patients hospitalized in the neurosurgery department of the FANN teaching hospital for the management of the CPA tumors, from January 2007 to December 2018.Results: CPA tumors accounted for 2.8% of intracranial tumors. The average age was 43.4 years and the sex ratio was 0.8. The main signs found were: vestibulo-cochlear syndrome in 66.7% of cases, cerebellar syndrome in 66.7% and HIC syndrome in 56.9% of cases. On imaging, the average size of the tumor was 4.8 cm. The most common tumor was meningioma. Hearing loss and facial paralysis were the most common sequelae. The most common complications are infectious. Conclusion:The tumor pathology of CPA is essentially composed of benign tumors, but of large size in our context making the management of its lesions delicate. Surgery is the main prognostic element found.

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Gamma Knife Stereotactic Radiosurgery for Nonvestibular Cranial Nerve Schwannomas

Cited by 19 publications

References 24 publications

Lower Cranial Nerve Schwannomas: Cohort Study and Systematic Review

Lower Cranial Nerve Schwannomas: Cohort Study and Systematic Review

The Long-Term Outcome of CyberKnife-Based Stereotactic Radiotherapy for Intra/ Extracranial Non-Vestibular Schwannomas: A Single-Center Experience

Management of Tumors of the Cerebellopontine Angle in Developing Countries: Experience of Fann Teaching Hospital in Dakar

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