Leksell Gamma Knife Radiosurgery for Trigeminal Schwannoma


Authors: M. Hynková 1;  R. Liščák 1;  D. Urgošík 1;  J. Vymazal 2
Authors‘ workplace: Oddělení stereotaktické a radiační neurochirurgie, Nemocnice Na Homolce, Praha 1;  Radiodiagnostické oddělení, Nemocnice na Homolce, Praha 2
Published in: Cesk Slov Neurol N 2007; 70/103(2): 178-185
Category: Short Communication

Overview

Within 12-year period (1992–2004) 19 patients with trigeminal schwannomas underwent Gamma Knife radiosurgery at our department of Na Homolce Hospital. Fifteen patients already had a follow-up after the treatment, and they were observed for the minimum of 12 and the maximum of 120 months, median 54 months. The group of patients consisted of 8 women and 7 men with the median age of 45 years. Seven patients underwent one to three microsurgical operations before radiosurgery. The tumour target volume ranged from 2 100 mm3 to 18 000 mm3 (median 9 600 mm3). Thirteen patients were subjected to irradiation of the whole tumour volume, in two cases the irradiation was only partial. The minimum tumour marginal dose ranged from 10 to 15 Gy (median 12 Gy) and it was delivered to 50 % isodose line. The tumour growth control was reached in 93 % (14 cases). In 3 patients, the tumour regressed completely, and in 8 patients there occurred a significant reduction of the tumour volume. No further tumour growth was seen in one case, progress appeared in three cases. Eleven (73 %) patients showed clinical improvement, 2 were without any change, and new neurological symptoms occurred in one patient. The fifteenth patient whose large tumour compressing the brain stem had been subjected to partial irradiation died of septicaemia 9 months after the treatment. Five patients had a cystic type of schwannomas, and four of them suffered from transient neurological deficits after irradiation as a consequence of an enlargement of the cystic part of the tumour. Two cases were tackled by stereopuncture, the third case was dealt with by the cyst marsupialisation. Radiosurgery has shown to be an effective primary as well as secondary treatment modality for small- and medium-size trigeminal schwannomas as the local tumour growth control is 93 % with a low morbidity.

Key words:
trigeminal schwannoma – trigeminal neurinoma – Leksell Gamma Knife – radiosurgery – stereotaxy – therapy


Sources

1. Verocay J. Zur kenntnis der neurofibrome. Beitr Pathol Anat 1910; 48: 1-69.

2. Stout AP. Peripheral manifestations of a specific nerve sheath tumor (neurilemmoma). Am J Cancer 1935; 24: 751-96.

3. Shrivastava RK, Strauss R, Post KD. Other schwannomas of cranial nerves. In: Kaye Andrew H (Ed). Brain tumors, an encyclopedic approach. 2. ed. San Diego (CA): Harcourt Trade Publishers 2001: 687-97.

4. Pan L, Wang E, Zhang N, Zhou L, Wang B, Dong Y et al. Long-term results of Leksell gamma knife surgery for trigeminal schwannomas. J Neurosurg (Suppl) 2005; 102: 220-4.

5. Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery 2003; 52(discussion 790): 783-90.

6. Day JD, Fukushima T. The surgical management of trigeminal neuromas. Neurosurgery 1998; 42: 233-40.

7. Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment og trigeminal schwannomas. J Neurosurg 1995; 82: 711-8.

8. Sarma S, Sekhar LN, Schessel DA. Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery 2002; 50(discussion 448-49): 437-48.

9. Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 1999; 91: 202-11.

10. Taha JM, Tew JM, van Loveren HR, Keller JT, El-Kalliny M. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 1995; 82: 719-25.

11. McCormick PC, Bello JA, Post KD. Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 1988; 69: 850-60.

12. Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemomas of the trigeminal nerve. J Neurosurgery 1989; 70(5): 737-45.

13. Liščák R, Vladyka V, Šubrt O. Leksellův Gama nůž – radiochirurgický nástroj. Čas Lék Čes 1995; 134: 531-3.

14. Vladyka V, Šubrt O, Liščák R. Radiochirurgie s užitím gama nože. Rozhl Chir 1994; 73: 348-55.

15. Chytka T, Liščák R, Vladyka V, Syrůček M, Vymazal J. Role radiochirurgie a stereotaxe v léčbě chordomů a chondrosarkomů báze lební. Česk Slov Neurol N 2003; 66/99: 288-96.

16. Huang C, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 1999; 45: 11-6.

17. Muthukumar N, Kondziolka D, Lunsford LD. Stereotactic radiosurgery for jugular foramen schwannomas. Surg Neurol 1999; 52: 172-9.

18. Ikushima I, Korogi Y, Kuratsu J, Hirai T, Hamatake S, Takahashi M et al. Dynamic MRI of meningiomas and schwannomas: is differential diagnosis possible? Neuroradiology 1997; 39; 633-8.

19. Nettel B, Niranjan A, Martin JJ, Koebbe CJ, Kondziolka D, Flickinger JC et al. Gamma knife radiosurgery for trigeminal schwannomas. Surg Neurol 2004; 62: 435-46.

20. Kida Y, Kobayashi T, Tanaka T. Radiosurgery of trigeminal neurinoma. In: Kondziolka D (Ed). Proceedings of Radiosurgery 1997. Basel (Switzerland): Karger 1998: vol 2: 8-15.

21. Pollock BE, Foote RL, Stafford SL. Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys 2002; 52(4): 1002-7.

22. Mabanta SR, Buatti JM, Friedman WA, Meeks SL, Mendenhall WM, Bova FJ. Linear accelerator radiosurgery for nonacoustics schwannomas. Int J Radiat Oncol Biol Phys 1999; 43(3): 545-8.

23. Zabel A, Debus J, Thilmann C, Schlegel W, Wannenmacher M. Management of benign cranial nonacoustic schwannomas by fractionated stereotactic radiotherapy. Intl J Cancer 2001; 96(6): 356-62.

24. Shirato H, Sakamoto T, Takeichi N. Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): comparison between cystic-type and solid-type VS. Int J Radiat Oncol Biol Phys 2000; 48(5): 1395-1401.

25. Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg 2002; 96: 453-63.

26. Konovalov AN, Spallone A, Mukhamedjanov DJ, Tcherekajev VA, Makhmudov UB. Trigeminal neurinomas. A series of 111 surgical cases from a single institution. Acta Neurochirurgica 1996; 138: 1027-35.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2007 Issue 2

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account