Trigeminal schwannomas: results of Gamma Knife surgery in 37 cases

View More View Less
  • 1 Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Information on outcomes of Gamma Knife surgery (GKS) for patients harboring trigeminal schwannomas is limited because these tumors are rare. The authors evaluated tumor control and functional outcomes in patients who underwent GKS for trigeminal schwannomas to clarify the efficacy of this treatment.

Methods

Forty-two patients with trigeminal schwannomas but no evidence of neurofibromatosis Type 2 were treated with GKS at Komaki City Hospital between November 1991 and December 2003. Of these, 37 patients were assessed. The mean tumor volume in these patients was 10 cm3. The mean maximum radiation dose directed to the tumor was 27.9 Gy and the mean dose directed to the tumor margin was 14.2 Gy. The mean follow-up period was 54 months. In four patients (11%) there was complete tumor remission; in 20 (54%) there was partial tumor remission; in eight (22%) the disease remained stable; and in five (14%) the tumor enlarged or uncontrollable facial pain developed with radiation-induced edema requiring resection. The actuarial 5- and 10-year tumor control rates were both 84%. With respect to functional outcomes, 40% of patients noted an improvement in their symptoms, and one patient experienced new symptoms despite good tumor control.

Conclusions

Gamma Knife surgery was a safe and effective treatment for a select group of patients harboring trigeminal schwannomas. Large tumors that compress the brainstem and cause deviation of the fourth ventricle should first be removed surgically and any remnant should be treated by GKS.

Abbreviations used in this paper:GKS = Gamma Knife surgery; MR = magnetic resonance; SRS = stereotactic radiosurgery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Toshinori Hasegawa, M.D., Department of Neurosurgery, Komaki City Hospital, Gamma Knife Center, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan. email: h-toshi@komakihp.gr.jp.
  • 1

    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 96:453463, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Arseni C, , Dumitrescu L, & Constantinescu A: Neurinomas of the trigeminal nerve. Surg Neurol 4:497503, 1975

  • 3

    Day JD, & Fukushima T: The surgical management of trigeminal neuromas. Neurosurgery 42:233241, 1998

  • 4

    Eisenberg MB, , Al-Mefty O, , DeMonte F, & Burson GT: Benign non-meningeal tumors of the cavernous sinus. Neurosurgery 44:949955, 1999

  • 5

    Goel A, , Muzumdar D, & Raman C: Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery 52:783790, 2003

  • 6

    Hasegawa T, , Fujitani S, , Katsumata S, , Kida Y, , Yoshimoto M, & Koike J: Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 57:257265, 2005

    • Search Google Scholar
    • Export Citation
  • 7

    Hasegawa T, , Kida Y, , Kobayashi T, , Yoshimoto M, , Mori Y, & Yoshida J: Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow-up. J Neurosurg 102:1016, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Iwai Y, , Yamanaka K, & Yoshimura M: Gamma knife radiosurgery for cavernous sinus metastases and invasion. Surg Neurol 64:406410, 2005

  • 9

    Jefferson G: The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clin Neurosurg 1:1154, 1953

    • Search Google Scholar
    • Export Citation
  • 10

    Kida Y, , Kobayashi T, & Mori M: Radiosurgery of cavernous hemangiomas in the cavernous sinus. Surg Neurol 56:117123, 2001

  • 11

    Kida Y, , Kobayashi T, & Tanaka T, Radiosurgery of trigeminal neurinoma. in Alexander E III, , Kondziolka D, , Lindquist C, & Loeffler JS: (eds) Radiosurgery, Vol 2 New York, Karger, 1997. pp 815

    • Search Google Scholar
    • Export Citation
  • 12

    Kondziolka D, , Lunsford LD, , McLaughlin MR, & Flickinger JC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:14261433, 1998

    • Search Google Scholar
    • Export Citation
  • 13

    Kondziolka D, , Nathoo N, , Flickinger JC, , Niranjan A, , Maitz AH, & Lunsford LD: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:815822, 2003

    • Search Google Scholar
    • Export Citation
  • 14

    Konovalov AN, , Spallone A, , Mukhamedjanov DJ, , Tcherekajev VA, & Makhmudov UB: Trigeminal neurinomas. A series of 111 surgical cases from a single institution. Acta Neurochir (Wien) 138:10271035, 1996

    • Search Google Scholar
    • Export Citation
  • 15

    Kuo JS, , Chen JCT, , Yu C, , Zelman V, , Giannotta SL, & Petrovich Z, : Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:13851394, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Lee JY, , Niranjan A, , McInerney J, , Kondziolka D, , Flickinger JC, & Lunsford LD: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97:6572, 2002

    • Search Google Scholar
    • Export Citation
  • 17

    Mabanta SR, , Buatti JM, , Friedman WA, , Meeks SL, , Mendenhall WM, & Bova FJ: Linear accelerator radiosurgery for nonacoustic schwannomas. Int J Radiat Oncol Biol Phys 43:545548, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Maruyama K, , Shin M, , Kurita H, , Kawahara N, , Morita A, & Kirino T: Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:10681075, 2004

    • Search Google Scholar
    • Export Citation
  • 19

    McCormick PC, , Bello JA, & Post KD: Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 69:850860, 1988

    • Search Google Scholar
    • Export Citation
  • 20

    Metellus P, , Rejis J, , Muracciole X, , Fuentes S, , Dufour H, & Nanni I, : Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57:873886, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Nettel B, , Niranjan A, , Martin JJ, , Koebbe CJ, , Kondziolka D, & Flickinger JC, : Gamma knife radiosurgery for trigeminal schwannomas. Surg Neurol 62:435446, 2004

    • Search Google Scholar
    • Export Citation
  • 22

    Pan L, , Wang EM, , Zhang N, , Zhou LF, , Wang BJ, & Dong YF, : Long-term results of Leksell gamma knife surgery for trigeminal schwannomas. J Neurosurg 102:Suppl 220224, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Peker S, , Kilic T, , Sengoz M, & Pamir MN: Radiosurgical treatment of cavernous sinus cavernous haemangiomas. Acta Neurochir (Wien) 146:337341, 2004

    • Search Google Scholar
    • Export Citation
  • 24

    Pollack IF, , Sekher LN, , Jannetta PJ, & Janecka IP: Neurilemomas of the trigeminal nerve. J Neurosurg 70:737745, 1989

  • 25

    Pollock BE, , Foote RL, & Stafford SL: Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?. Int J Radiat Oncol Biol Phys 52:10021007, 2002

    • Search Google Scholar
    • Export Citation
  • 26

    Pollock BE, , Kondziolka D, , Flickinger JC, , Maiz A, & Lunsford LD: Preservation of cranial nerve function after radiosurgery for non-acoustic schwannomas. Neurosurgery 33:597601, 1993

    • Search Google Scholar
    • Export Citation
  • 27

    Pollock BE, & Stafford SL: Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int Radiat Oncol Biol Phys 62:14271431, 2005

    • Search Google Scholar
    • Export Citation
  • 28

    Samii M, , Migliori MM, , Tatagiba M, & Babu R: Surgical treatment of trigeminal schwannomas. J Neurosurg 82:711718, 1995

  • 29

    Schisano G, & Olivecrona H: Neurinomas of the Gasserian ganglion and trigeminal root. J Neurosurg 17:306322, 1960

  • 30

    Taha JM, , Tew JM Jr, , Van Loveren HR, , Keller JT, & el-Kalliny M: Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 82:719725, 1995

    • Search Google Scholar
    • Export Citation
  • 31

    Thompson TP, , Lunsford LD, & Flickinger JC: Radiosurgery for hemangioblastoma of the cavernous sinus and orbit: technical case report. Neurosurgery 47:778783, 2000

    • Search Google Scholar
    • Export Citation
  • 32

    Wallner KE, , Pitts LH, , Davis RL, & Sheline GE: Radiation therapy for the treatment of non-eight nerve intracranial neurilemmoma. Int J Radiat Oncol Biol Phys 14:287290, 1988

    • Search Google Scholar
    • Export Citation
  • 33

    Yamasaki T, , Nagao S, , Kagawa T, , Takamura M, , Moritake K, & Tanaka Y, : [Therapeutic effectiveness of combined microsurgery and radiosurgery in a patient with a huge trigeminal neurinoma.]. No To Shinkei 48:845850, 1996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 34

    Yasui T, , Hakuba A, , Kim SH, & Nishimura S: Trigeminal neurinomas: operative approach in eight cases. J Neurosurg 71:506511, 1989

  • 35

    Yoshida K, & Kawase T: Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 91:202211, 1999

    • Search Google Scholar
    • Export Citation
  • 36

    Zabel A, , Debus J, , Thilmann C, , Schlegel W, & Wannenmacher M: Management of benign cranial nonacoustic schwannomas by fractionated stereotactic radiotherapy. Int J Cancer 96:356362, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 695 173 13
Full Text Views 113 4 1
PDF Downloads 111 1 1
EPUB Downloads 0 0 0