Radiosurgery for facial schwannoma

Kida, Yoshihisa; Yoshimoto, Masayuki; Hasegawa, Toshinori

doi:10.3171/jns.2007.106.1.24

Cited by 59 publications

(49 citation statements)

References 17 publications

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“…Recently, radiotherapy has been advocated as a less invasive alternative primary treatment in patients with FNSs [Mabanta et al, 1999;Kida et al, 2007;Litre et al, 2007;McClelland et al, 2007;Hillman et al, 2008;Madhok et al, 2009;Nishioka et al, 2009, Wilkinson et al, 2011. The efficiency of radiotherapy in long-term tumor control is still unknown, and further studies with longer follow-up are necessary [Marzo et al, 2009].…”

Section: Discussionmentioning

confidence: 99%

“…These procedures comprise subtotal tumor removal, facial nerve decompression, and fascicle preservation surgery. Recently, radiotherapy has been advocated as a primary therapeutic option in patients with FNS [Kida et al, 2007;Litre et al, 2007;McClelland et al, 2007;Hillman et al, 2008;Madhok et al, 2009]. During the last decade various management algorithms have been developed in order to standardize treatment of FNS [Marzo et al, 2009;Bäck et al, 2010;Wilkinson et al 2011;Gross et al, 2012].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Bacciu

Nusier²,

Lauda³

et al. 2013

Audiol Neurotol

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Objectives: To describe the decision-making strategies for complex facial nerve schwannomas (FNSs). Materials and Methods: Charts belonging to 103 consecutive patients with facial nerve tumors managed between 1990 and 2011 were examined retrospectively to identify complex FNSs. To be classified as complex, at least one of the following criteria had to be met: (1) FNS with large intraparotid tumor component and preoperative good facial nerve function (3 cases); (2) multiple-segment FNSs with extension to both the cerebellopontine angle and the middle cranial fossa in patients with preoperative good hearing (5 cases); (3) fast-growing FNS with preoperative good facial nerve function (4 cases), and (4) large FNS compressing the temporal lobe with preoperative normal facial nerve function (1 case). Results: Thirteen patients were classified as complex; 12 patients had total tumor removal with sural nerve grafting and 1 patient had partial tumor removal.Two patients with intratemporal-intraparotid FNS underwent a transmastoid-transparotid approach. One patient with a tumor extending from the geniculate ganglion to the parotid portion of the facial nerve underwent a combined middle fossa transmastoid-transparotid approach.A transcochlear approach with temporal craniotomy was performed in all the patients with multiple-segment FNS as well as in patients with fast-growing tumors extending both in the cerebellopontine angle and middle cranial fossa. A partial tumor removal through the middle fossa approach was performed in 1 patient with a large tumor compressing the temporal lobe. Conclusions: Therapeutic options for patients with FNS include surgical intervention, observation and radiotherapy. Nowadays, surgical resection with facial nerve repair is usually the standard management for patients with poor facial function (House-Brackmann grade III or worse). In patients presenting with normal or near-normal facial nerve function, initial observation with periodic examination and imaging is usually recommended. However, on rare occasions surgeons can be faced with a situation in which the management decision-making process is particularly challenging. In these complex cases treatment should be individualized. We recommend early surgical intervention regardless of the preoperative facial and hearing functions in the following cases: intratemporal FNSs extending with a large tumor component into the parotid, multiple-segment FNSs extending in both the cerebellopontine angle and the middle cranial fossa, fast-growing FNSs, and large FNSs with temporal lobe compression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Bacciu

Nusier²,

Lauda³

et al. 2013

Audiol Neurotol

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show abstract

“…23 During the last 3 decades, SRS has emerged as another possible treatment option. There are several reports that showed the safety and efficacy of SRS for patients with FNSs, 2,3,5,17,18,21,22 but the reported studies generally included a small number of patients. To our knowledge, ours is the largest study to date of FNSs treated with SRS.…”

Section: Discussion Treatment Optionsmentioning

confidence: 99%

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

Hasegawa

Kato

Kida

et al. 2016

JNS

Self Cite

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obJective The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs). methods This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm 3 , and the median prescription dose to the tumor margin was 12 Gy. results The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing. coNclusioNs GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.

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“…2,6,10,15,21,29,48,49,55 Sheehan and colleagues 45 have reported excellent results using GKS in 26 patients with trigeminal schwannomas, and Hasegawa and associates 14 found similar results in 37 patients. Kida et al 18 reported a 100% tumor control rate of facial neuromas after a mean follow-up of 31 months with GKS. Litre et al 28 reported that 10 of 11 patients with facial schwannomas were stable after this same treatment.…”

Section: Schwannomasmentioning

confidence: 99%

Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

Johnson

Loredo

Slater

2008

FOC

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✓ Historically, radiation therapy has been used extensively in the treatment of malignant and aggressive intracranial tumors, and the importance of its role has been repeatedly verified by prolonged patient survival rates and increased tumor control. As more modern capabilities are employed in surgery and radiotherapy, attention is being directed to the utility of radiation as either primary or secondary treatment of benign tumors. Specifically, primary treatment encompasses irradiation of small benign tumors without biopsy confirmation of tumor type; secondary treatment involves postoperative radiation therapy, with the possibility that less-aggressive tumor resection may be performed in areas that have a higher probability of resultant neurological deficit. Current literature suggests that this is not only a possible treatment strategy, but that it may be superior to more radical resection in some cases, for example, in vestibular schwannomas and meningiomas. This article provides an overview of factors to consider in the use of radiation therapy and reviews the relationships between radiation and surgery, notably the unique complementary role each plays in the treatment of benign intracranial tumors.

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Radiosurgery for facial schwannoma

Abstract: In summary, radiosurgery was found to be a very useful method of treating facial schwannoma, for both tumor control and functional control. Radiosurgery should therefore be the treatment of first choice for facial schwannomas.

Cited by 59 publications

References 17 publications

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Are the Current Treatment Strategies for Facial Nerve Schwannoma Appropriate Also for Complex Cases?

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

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