Stereotactic Radiosurgery for Trigeminal Schwannoma: A Clinical Retrospective Study in 52 Cases

Sun, Jun-Zhao; Zhang, Jianning; Yu, Xinguang; Qi, Shunan; Du, Yanan; Ni, Wei-gang; Hu, Yong; Tian, Zeng-min

doi:10.1159/000345258

Cited by 28 publications

(23 citation statements)

References 36 publications

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“…32 Sun et al treated 52 patients with trigeminal schwannomas with radiosurgery using rotating gamma unit. 33 They reported a tumor control rate of 86.5% with near-total resolution in 15.4%, regression in 61.5%, unchanged tumor in 9.6%, and enlargement in 13.5% patients.…”

Section: Stereotactic Radiosurgerymentioning

confidence: 94%

“…32 In a study by Sun et al, the rate of improvement of presenting neurologic symptoms was 67.3%. 33 Radical surgical resection provides the best long-term control rate at the price of the highest incidence of neurologic deficits. Size obviously matters in terms of treatment strategies and often strongly influences the initial recommendation.…”

Section: Management Of Trigeminal Schwannomasmentioning

confidence: 99%

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Multimodality Management of Trigeminal Schwannomas

et al. 2016

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Patients presenting with trigeminal schwannomas require multimodality management by a skull base surgical team that can offer expertise in both transcranial and transnasal approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic symptoms, preservation of cranial nerve function, and control of mass effect are the primary goals of management for trigeminal schwannomas. Complete surgical resection is the treatment of choice but may not be possible in all cases. Radiosurgery is an option as primary management for small- to moderate-sized tumors and can be used for postoperative residuals or recurrences. Planned surgical resection followed by SRS for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic resection is an excellent approach for patients with an extradural tumor or tumors isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based on high-quality imaging can help better estimate the expected outcome from each treatment. An expert skull base team should be able to provide precise counseling for each patient's situation for selecting the best option.

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Section: Stereotactic Radiosurgerymentioning

confidence: 94%

Section: Management Of Trigeminal Schwannomasmentioning

confidence: 99%

Multimodality Management of Trigeminal Schwannomas

et al. 2016

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“…16,19,21 However, on average, the number of patients per study was 39, marginal dose was 14.5 Gy, tumor volume was 5.5 cm 3 , time to follow-up was 56 months, chance of clinical improvement was 48%, chance of tumor control was 91%, and chance of clinical worsening or new symptoms was 12% (most commonly trigeminal neuropathy/pain). 1, [14][15][16][17][18][19][20][21][22][23][24] Kano et al found that a higher marginal dose was correlated with improved tumor control. 1 Snyder et al found that a higher marginal dose was associated with increased rates of tumor expansion.…”

Section: Review Of Stereotactic Radiosurgery For Trigeminal Schwannomasmentioning

confidence: 99%

“…Management strategies for TS include observation (in incidentally discovered tumors), partial or complete microsurgical resection, [3][4][5][6][7][8][9][10][11][12][13] or stereotactic radiosurgery (SRS). 1,[14][15][16][17][18][19][20][21][22][23][24] Initial microsurgical resection is necessary for larger volume tumors causing symptomatic brainstem compression. SRS is a primary management strategy for smaller volume tumors and as an adjuvant salvage option after attempted resection of larger tumors associated with symptomatic mass effect.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Response to Trigeminal Schwannoma Radiosurgery: A Retrospective Analysis of a 28-Year Experience

Niranjan

Raju

Kano

et al. 2020

J Neurol Surg B Skull Base

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Objective The purpose of this study was to evaluate long-term clinical outcomes and tumor control after stereotactic radiosurgery (SRS) for trigeminal schwannoma (TS). Methods During a 28-year period (1989–2017), 50 patients underwent SRS for TS. The median patient age was 51 years (range: 15–87 years). A total of 17 patients had a previous tumor resection: 10 had a single procedure, 5 had two procedures, and 2 had three procedures. The median and mean times between tumor resection and SRS were 12 and 24 months (range: 1–90 months), respectively. Four patients had neurofibromatosis II (NF2). Based on location, tumors were classified as root type (7), ganglion type (22), or dumbbell type (21). The median radiosurgery target volume was 3.4 cm3 (range: 0.10–18 cm3), median target dose was 14 Gy (range: 12–20 Gy), and the median number of isocenters was 6 (range: 1–15). The median and mean times to last follow-up was 36.9 and 55.2 months (range: 4–205 months), respectively. Eighteen patients (36%) had longer than 5-year follow-up, and seven patients (14%) had longer than 10-year follow-up. Results The tumor control rate was 92% and the clinical improvement or stabilization rate was 94%. After SRS, the rates of progression free survival (PFS) at 1, 5, and 10 years were 98, 84, and 84%, respectively. Factors associated with improved PFS were female sex (p = 0.014) and smaller tumor volume (p = 0.022). In this series, we did not find that tumor type (root, ganglion, and dumbbell) had a statistically significant correlation to PFS. Forty-seven patients had neurological signs or symptoms at presentation. At last follow-up, neurological signs or symptoms improved in 22/47 (47%), remained unchanged in 24/50 (48%), and worsened due to tumor progression in 3/50 (6%). One patient (2%) developed temporary symptomatic adverse radiation effect (ARE) and three additional patients (6%) had transient imaging evidence of peritumoral reactive edema but no new symptoms. Conclusion As a single outpatient procedure, SRS was associated with long-term freedom from additional management in 84% of patients. Nearly half the treated patients experienced improvement in neurological symptoms or signs.

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“…1 These tumors of the skull base account for 0.07 to 0.36% of intracranial tumors and 1 to 8% of adult intracranial schwannomas, but they can make up around 10% of schwannomas encountered in adolescence. [2][3][4][5][6] This correlates to an approximate incidence of 1 case per 100,000 inhabitants, affecting predominantly women between the fourth and sixth decade of life. Malignant TS are very infrequently reported and mainly occur associated with neurofibromatosis type 1.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical Management of Trigeminal Schwannoma: Cohort Analysis and Systematic Review

et al. 2018

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Background Trigeminal schwannomas are benign tumors with a predilection for women between 40 and 60 years of age and account for less than 0.5% of all intracranial tumors. Clinical presentation depends on size and location, and typical symptoms are ipsilateral hypesthesia, headache, and facial pain. Clinical features and imaging usually make the Diagnosis. Methods A retrospective cohort analysis of 14 patients treated at our institution between January 1999 and October 2016 was performed, with a critical and systematic review of data from the literature, focusing on articles published over the same period. Results Fourteen patients were included in our series comprised of mostly women with a mean age of 40 years. Lesion size ranged from 3 to 6.5 cm (mean 4.6 cm). Clinical status of patients was evaluated and also rated based on the Karnofsky Perfomance Scale with values greater than 90% found in all patients pre and postoperatively. Surgery was our treatment of choice, and gross total resection was achieved in 71% of patients. Associated morbidity was high at 57%, predominantly from cranial nerve palsy, and no deaths were encountered. Conclusions Microsurgery is a suitable treatment for large symptomatic trigeminal schwannomas, achieving good local control rates over the observation period at acceptable morbidity. Therefore, microsurgery appears to a suitable option. During the study period, a significant evolution in the availability of treatment methods occurred. Radiosurgery emerged as an alternative treatment for unresectable lesions. A comprehensive review of the available literature was performed, and results were compared according to treatment modality.

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Stereotactic Radiosurgery for Trigeminal Schwannoma: A Clinical Retrospective Study in 52 Cases

Cited by 28 publications

References 36 publications

Multimodality Management of Trigeminal Schwannomas

Multimodality Management of Trigeminal Schwannomas

Clinical and Imaging Response to Trigeminal Schwannoma Radiosurgery: A Retrospective Analysis of a 28-Year Experience

Microsurgical Management of Trigeminal Schwannoma: Cohort Analysis and Systematic Review

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