Upfront Gamma Knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review

Tuleasca, Constantin; Goncalves-Matoso, Beatrice; Schiappacasse, Luis; Marguet, Maud; Levivier, Marc

doi:10.1007/s00701-018-3503-2

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Large tumors can be treated using subtotal or gross total resection followed by GKR, as previously published in non-vestibular [8,29,49] and vestibular schwannomas [8,46]. Other approaches might include staged volume radiosurgery, in selected cases [7]. Challenging aspects might be related to the proximity with the optic apparatus.…”

Section: Discussionmentioning

confidence: 99%

“…Stereotactic radiosurgery (SRS) is considered a valuable therapeutic alternative for treating benign intracranial tumors, due to its minimal invasiveness as well as to its safety profile and efficacy on vestibular [14,24,34,44,45] and nonvestibular schwannomas [7,29]. Twenty years ago, a first report by Huang et al [16] evaluated the role of SRS by Gamma Knife (GK) in trigeminal nerve schwannomas.…”

Section: Introductionmentioning

confidence: 99%

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Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Peciu-Florianu¹,

Régis²,

Levivier

et al. 2020

Neurosurg Rev

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Trigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Peciu-Florianu¹,

Régis²,

Levivier

et al. 2020

Neurosurg Rev

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“…44 Candidly, given that most studies of SRS reported essentially a zero incidence of degraded facial function, the differences observed in outcome may be predominantly driven by unfavorable outcomes following surgery, rather than favorable outcomes following SRS. 5,6,38,40 We did not identify a statistically significant difference in the incidence of complications, which ranged from 4% to 7%, or risk of progression, which ranged from 2% to 3% across all included studies, although the certainty of these findings is low. With respect to complications, we do note that, looking more broadly at the literature comparing out-comes after SRS and surgery, treatment-related morbidity and complications are almost universally lower following radiosurgery.…”

Section: Discussionmentioning

confidence: 68%

“…Screening against all selection criteria yielded 74 candidate studies, which underwent full-text analysis. Overall, 33 surgical 1,4, and radiosurgical 1,[5][6][7]19,[38][39][40][41][42] studies satisfied inclusion criteria into this study.…”

Section: Search Strategymentioning

confidence: 99%

Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression

Rotter¹,

Lu²,

Graffeo³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIntracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis.METHODSA search of the Ovid EMBASE, PubMed, SCOPUS, and Cochrane databases from inception to July 2019 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. Facial nerve outcomes were classified as improved, stabilized, or worsened by last follow-up. Incidence was pooled by random-effects meta-analysis of proportions.RESULTSThirty-three articles with a pooled cohort of 519 patients with FNS satisfied all criteria. Twenty-five articles described operative outcomes in 407 (78%) patients; 10 articles reported SRS outcomes in 112 (22%). In the surgical cohort, facial nerve function improved in 23% (95% CI 15%–32%), stabilized in 41% (95% CI 32%–50%), and worsened in 30% (95% CI 21%–40%). In the SRS cohort, facial nerve function was improved in 20% (95% CI 9%–34%), stable in 66% (95% CI 54%–78%), and worsened in 9% (95% CI 3%–16%). Compared with SRS, microsurgery was associated with a significantly lower incidence of stable facial nerve function (p < 0.01) and a significantly higher incidence of worsened facial nerve function (p < 0.01). Tumor progression and complication rates were comparable. Outcome certainty assessments were very low to moderate for all parameters.CONCLUSIONSUnfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.

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“…PubMed (Comps et al, 2018) Upfront gamma knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review.…”

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confidence: 99%

Tratamento para neurilemoma de cabeça e pescoço: uma revisão integrativa

Portela

Pessoa

Oliveira

et al. 2023

RSD

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O Neurilemoma ou Schwannoma é uma neoplasia benigna de proveniência neural originado na célula de Schwann, que pode ser considerado relativamente incomum, e que atinge tecidos moles da região de cabeça e pescoço, sendo notados nessas regiões em 25 % a 48% dos casos. O diagnóstico é realizado pelo exame histopatológico, e o tratamento mais indicado é a excisão cirúrgica conservadora, com prognóstico favorável, não devendo a lesão recidivar ou apresentar transformações malignas. Assim, o objetivo do estudo é discorrer sobre os principais tratamentos disponíveis para o Neurilemoma, através de uma revisão integrativa da literatura. Este estudo foi realizado no período de Fevereiro de 2023 até Abril de 2023, por meio de revisão da literatura de artigos científicos obtidos nas bases de dados Scielo, PubMed e Google acadêmico em que foram incluídos artigos diretamente relacionados à temática do trabalho. Vários são os métodos de tratamento para o Neurilemoma, sendo a excisão cirúrgica o método mais comumente utilizado. Também existem opções inovadoras, como a Faca Gama, e Radioterapia Estereotáxica Hipofracionada de Cinco Frações com Acelerador Linear, podendo ser utilizadas em conjunto a fim de garantir maior eficiência no tratamento. A excisão cirúrgica ainda é o método de tratamento mais utilizado para Neurilemomas. No entanto, outros métodos têm sido utilizados, com vistas a garantir um maior benefício no tratamento.

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Upfront Gamma Knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review

Cited by 9 publications

References 35 publications

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression

Tratamento para neurilemoma de cabeça e pescoço: uma revisão integrativa

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