scholarly journals Gamma Knife Surgery for Facial Nerve Schwannomas

2008 ◽  
pp. 131-135 ◽  
Author(s):  
C.F. Litré ◽  
G. Pech Gourg ◽  
M. Tamura ◽  
P.-H. Roche ◽  
J. Régis
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Gamma Knife Surgery

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

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 853-859 ◽  
Author(s):  
Claude F. Litre ◽  
Grégoire P. Gourg ◽  
Manabu Tamura ◽  
Driss Mdarhri ◽  
Adil Touzani ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Facial Palsy ◽  
Radical Resection ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Medium Size ◽  
Functional Evaluation ◽  
Facial Function

Abstract OBJECTIVE Radical resection of facial nerve schwannomas classically implies a high risk of severe facial palsy. Owing to the rarity of facial palsy after gamma knife surgery (GKS) of vestibular schwannomas, functional evaluation after GKS seems rational in this specific group of patients. To our knowledge, no previous similar evaluation exists in the literature. METHODS Of 1783 schwannomas of the cerebellopontine angles treated by GKS at Timone University Hospital between July 1992 and May 2003, 11 were diagnosed as originating from the facial nerve. Criteria for this diagnosis were the involvement of the tympanic or mastoid segment of the facial nerve (n = 9) and/or preoperative observation of a facial nerve deficit that had occurred during previous microsurgery (two patients). The rare occurrence of facial palsy after vestibular schwannoma radiosurgery, usually within 18 months of treatment, has been considered only in the patients with more than 2 years of follow-up (n = 9). RESULTS Six of these patients experienced a previous spontaneous facial palsy on one (n = 4) or several occasions (n = 2). A normal motor facial function was observed in only three patients before GKS (House-Brackmann Grade II in six patients, Grade III in one patient, Grade IV in one patient). The median follow-up period was 39 months (range, 18–84 mo). At the time of the last follow-up examination, no patients had developed a new facial palsy or experienced deterioration of a preexisting facial palsy and three patients had improvement of a preoperative facial palsy. Ten out of the 11 tumors are stable or decreased in size; in the other, a microsurgical resection of the tumor had been recommended owing to the development of a cyst. Clinical management owing to the specificity and heterogeneity of this group of patients has required the development of an original classification of four anatomic subtypes presenting different clinical and surgical difficulties. CONCLUSION This first study demonstrates that radiosurgery allows treatment of these patients while preserving normal motor facial function. Such an advantage should lead to the consideration of GKS as a first treatment option for small- to medium-size facial nerve schwannomas.

Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma

2013 ◽  
Vol 118 (3) ◽  
pp. 566-570 ◽  
Author(s):  
Seong-Hyun Park ◽  
Kyu-Yup Lee ◽  
Sung-Kyoo Hwang
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Primary Treatment ◽  
Nasal Secretion ◽  
Point Of View ◽  
Gamma Knife Surgery ◽  
Taste Disturbance ◽  
Before And After ◽  
Nervus Intermedius

Object The purpose of this study was to evaluate the function of the nervus intermedius, the nonmotor component of the facial nerve, following modern Gamma Knife surgery (GKS) for the treatment of vestibular schwannoma. Methods Sixty-five consecutive patients at our center underwent GKS as a primary treatment option for vestibular schwannoma between 2005 and 2010. The authors interviewed patients with a functional questionnaire to evaluate the function of the nervus intermedius before and after radiosurgery from their subjective point of view. Data from 50 patients treated using GKS for a unilateral vestibular schwannoma were obtained. Results Nine (18%) of 50 patients presented with at least one preradiosurgical disturbance of the nervus intermedius caused by the vestibular schwannoma itself, with dysfunctions of lacrimation, salivation, nasal secretion, and taste. Of the 41 patients without preradiosurgical disturbances, 9 (22%) experienced the onset of at least one new disturbance after GKS. Specifically for each dysfunction, of the 45 patients without a lacrimal disturbance before GKS, 5 (11.1%) had a new lacrimal disturbance after GKS. New onset of a salivary disturbance after GKS was reported in 3 (6.2%) of 48 patients. In 1 patient (2%), increased nasal secretion was noted 1 year after GKS. Five (10.6%) of 47 patients without a preradiosurgical taste disturbance experienced the symptom after GKS. No facial palsy developed in any patient before or after GKS. There was no significant correlation between postradiosurgical nervus intermedius dysfunction and tumor size, margin dose, or patient age. Conclusions The authors demonstrated that 22% of patients undergoing modern GKS for vestibular schwannoma experience various disturbances of nonmotor components of the facial nerve as a result of the radiosurgery. Through this study, we can provide useful information about the likelihood of certain postradiosurgical symptoms for vestibular schwannoma.

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

2016 ◽  
Vol 124 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Takenori Kato ◽  
Yoshihisa Kida ◽  
Motohiro Hayashi ◽  
Takahiko Tsugawa ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Facial Palsy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Safe Alternative

OBJECT 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 cm3, 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.

Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience

2005 ◽  
Vol 102 ◽  
pp. 114-118 ◽  
Author(s):  
Berndt Wowra ◽  
Alexander Muacevic ◽  
Anja Jess-Hempen ◽  
John-Martin Hempel ◽  
Stefanie Müller-Schunk ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Radiation Toxicity ◽  
Content Type ◽  
Therapeutic Profile ◽  
Fine Print

Object.The purpose of the study was to define the therapeutic profile of outpatient gamma knife surgery (GKS) for vestibular schwannoma (VS) by using sequential tumor volumetry to quantify changes following treatment.Methods.A total of 111 patients met the inclusion criteria. The median follow-up duration was 7 years (range 5–9.6 years). Thirty-seven patients (33%) had undergone surgery before GKS and 10 (9%) had neurofibromatosis Type 2 (NF2). The median VS volume was 1.6 cm3(range 0.08–8.7 cm3).The actuarial 6-year tumor control rate after a single GKS treatment was 95%. Tumor swelling was observed in 43 patients (38.7%). Recurrence was significantly associated with NF2 (p < 0.003) and the reduced dose (p < 0.03) delivered to these tumors. The incidence of facial nerve neuropathy was mainly determined by surgery prior to GKS (p < 0.0001). Facial nerve radiation toxicity was mild and transient. No permanent facial nerve toxicity was observed. Trigeminal neuropathy occurred in 13 patients, and this was correlated with the VS volume (p < 0.02). The median hearing loss was −10 dB (range + 20 dB to −70 dB). The risk of hearing loss was correlated with age and transient tumor swelling (p < 0.05) but not with dose parameters or NF2.Conclusions.Outpatient GKS is feasible, effective, and safe. Its therapeutic profile compares favorably with that of microsurgery.

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.

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

2018 ◽  
Vol 160 (5) ◽  
pp. 987-996 ◽  
Author(s):  
Jean-Nicolas Comps ◽  
Constantin Tuleasca ◽  
Beatrice Goncalves-Matoso ◽  
Luis Schiappacasse ◽  
Maud Marguet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Gamma Knife ◽  
Case Series ◽  
Gamma Knife Surgery ◽  
Retrospective Case ◽  
Series Analysis ◽  
Retrospective Case Series

Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 114-118 ◽  
Author(s):  
Berndt Wowra ◽  
Alexander Muacevic ◽  
Anja Jess-Hempen ◽  
John-Martin Hempel ◽  
Stefanie Müller-Schunk ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Radiation Toxicity ◽  
Content Type ◽  
Therapeutic Profile ◽  
Fine Print

Object. The purpose of the study was to define the therapeutic profile of outpatient gamma knife surgery (GKS) for vestibular schwannoma (VS) by using sequential tumor volumetry to quantify changes following treatment. Methods. A total of 111 patients met the inclusion criteria. The median follow-up duration was 7 years (range 5–9.6 years). Thirty-seven patients (33%) had undergone surgery before GKS and 10 (9%) had neurofibromatosis Type 2 (NF2). The median VS volume was 1.6 cm3 (range 0.08–8.7 cm3). The actuarial 6-year tumor control rate after a single GKS treatment was 95%. Tumor swelling was observed in 43 patients (38.7%). Recurrence was significantly associated with NF2 (p < 0.003) and the reduced dose (p < 0.03) delivered to these tumors. The incidence of facial nerve neuropathy was mainly determined by surgery prior to GKS (p < 0.0001). Facial nerve radiation toxicity was mild and transient. No permanent facial nerve toxicity was observed. Trigeminal neuropathy occurred in 13 patients, and this was correlated with the VS volume (p < 0.02). The median hearing loss was −10 dB (range + 20 dB to −70 dB). The risk of hearing loss was correlated with age and transient tumor swelling (p < 0.05) but not with dose parameters or NF2. Conclusions. Outpatient GKS is feasible, effective, and safe. Its therapeutic profile compares favorably with that of microsurgery.

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