Radiosurgery for facial schwannoma

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Object

The aim of this study was to evaluate the results of radiosurgery in patients with facial schwannoma.

Methods

The study population consisted of 14 patients, six men and eight women, with a mean age of 45.4 years. Most of the patients had presented with facial palsy (11 of 14 patients) and/or hearing disturbance (nine of 14 patients). Prior treatment in nine of the 14 cases consisted of tumor resection or tumor biopsy. Tumor volume ranged from 0.98 to 20.8 cm3, and the mean tumor volume was 5.5 cm3. The mean maximum radiation dose and mean tumor margin dose used for radiosurgery were 24.0 and 12.9 Gy, respectively.

During the mean follow-up period of 31.4 months (range 12–120 months), 10 of the tumors shrank and four remained unchanged. The tumor response and tumor control rates were 57 and 100%, respectively. None of the tumors progressed, and no subsequent resection was required. Facial nerve function improved in five cases, remained unchanged in eight, and became worse in one. There was no change in hearing function in any of the patients. Complications developed in only one patient: the onset of facial palsy immediately after treatment, which subsequently recovered to House–Brackmann Grade III.

Conclusions

In summary, radiosurgery was found to be a very useful method of treating facial schwannoma, for both tumor control and functional control. Radiosurgery should therefore be the treatment of first choice for facial schwannomas.

Abbreviations used in this paper:CPA = cerebellopontine angle; GK = Gamma Knife; MR = magnetic resonance; VS = vestibular schwannoma.

Article Information

Address reprint requests to: Yoshihisa Kida, M.D., Department of Neurosurgery, Komaki City Hospital, 1-20, Jhobusi, Komaki City, Aichi Prefecture, Japan. email: yoshi9@go2.enjoy.ne.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial (left) and coronal (right) contrast-enhanced T1-weighted MR images showing a typical facial schwannoma of the geniculate ganglion extending into the middle cranial fossa.

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    Bar graph demonstrating the response of facial schwannomas to radiosurgery during the follow-up evaluation (mean duration 31.4 months). CR = complete remission; PG = progression. See Table 3 footnote for explanation of additional abbreviations.

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    Bar graph revealing neurological changes in hearing and facial nerve function after radiosurgery. Light gray bars represent facial nerve function; dark gray bars hearing function.

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    Case 1. Magnetic resonance images obtained before radiosurgery (A) and 20 (B) and 56 (C) months after radio-surgery, revealing marked shrinking of a facial schwannoma causing a facial palsy.

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    Case 9. Magnetic resonance images obtained before radiosurgery (A) and 60 (B) and 120 (C) months after radio-surgery, demonstrating progressive shrinkage of multiple schwannomas associated with neurofibromatosis Type 2. Both trigeminal and facial schwannomas showed persistent shrinkage after radiosurgery.

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