Gamma Knife surgery for abducent nerve schwannoma

Report of 4 cases

Motohiro HayashiDepartment of Neurosurgery and
Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;
Saitama Gamma Knife Center, Sanai Hospital, Saitama; and
RIT Kasai, Kasai Cardiology and Neurosurgery Hospital, Kasai, Japan; and

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Mikhail ChernovDepartment of Neurosurgery and
Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;
Diagnostic and Treatment Center, International Institute of the Biological Systems, Saint Petersburg, Russia

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Noriko TamuraDepartment of Neurosurgery and

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Shoji YomoSaitama Gamma Knife Center, Sanai Hospital, Saitama; and

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Taku OchiaiSaitama Gamma Knife Center, Sanai Hospital, Saitama; and

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Mariko NagaiRIT Kasai, Kasai Cardiology and Neurosurgery Hospital, Kasai, Japan; and

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Manabu TamuraFaculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;

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Masahiro IzawaDepartment of Neurosurgery and

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Yoshihiro MuragakiDepartment of Neurosurgery and
Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;

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Hiroshi IsekiDepartment of Neurosurgery and
Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;

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Yoshikazu OkadaDepartment of Neurosurgery and

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Kintomo TakakuraFaculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo;

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Abducent nerve schwannomas are extremely rare. The authors recently performed Gamma Knife surgery (GKS) in 4 patients with such tumors and describe their experiences with these cases.

The patients consisted of 3 women and 1 man whose ages varied from 31 to 60 years (mean 46 years). Two patients had no symptoms, 1 complained of slight visual disturbances, and the other 1 had abducent nerve palsy. Neurofibromatosis was not diagnosed in any case. All 4 tumors were located in the cavernous sinus: 2 of these tumors within the borders of the sinus, 1 tumor extending into the orbit, and 1 tumor extending into the prepontine cistern. The volume of the neoplasms varied from 1.7 to 4.9 cm3 (mean 3.0 cm3). No patient underwent tumor resection. Treatment was delivered with the aid of a Leksell Gamma Knife model C unit and the automatic positioning system. The dose directed to the tumor margin was 12 Gy in all cases. The dose directed to the anterior visual pathways was kept below 10 Gy and that to the brainstem below 14 Gy. The length of follow-up varied between 7 and 43 months (mean 27 months).

There were no acute complications or side effects. Imaging studies showed temporary enlargement of all tumors during the 1st posttreatment year, but thereafter, there was a trend toward reduction in volume. None of the neoplasms displayed regrowth. In the 3 patients who did not have abducent nerve palsy before GKS, it appeared, at least temporarily, after the procedure. Purely intracavernous neoplasms in general followed uneventful posttreatment courses, but dumbbell-shaped tumors were associated with significant morbidity. The cisternocavernous schwannoma underwent cystic degeneration 2 years after GKS, and the patient developed diplopia. After GKS, the patient treated for an orbitocavernous schwannoma experienced a significant deterioration in vision, temporary blindness in 1 eye, and late development of permanent abducent nerve palsy, which were seemingly caused by compression of neurovascular structures within the anulus of Zinn during a temporary increase in the lesion's volume after irradiation.

Gamma Knife surgery controls the growth of abducent nerve schwannomas and may be effectively used to manage intracavernous neoplasms. Caution, however, should be used in cases of dumbbell-shaped tumors, particularly those extending through the superior orbital fissure.

Abbreviations used in this paper:

GKS = Gamma Knife surgery; SRT = stereotactic radiotherapy.
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  • 1

    Acharya R, , Husain S, , Chhabra SS, , Patir R, , Bhalla S, & Seghal AD: Sixth nerve schwannoma: a case report with literature review. Neurol Sci 24:7479, 2003

    • Search Google Scholar
    • Export Citation
  • 2

    Barat JL, , Marchal JC, , Bracard S, , Auque J, , Martin-Beuzart S, & Hepner H: [Neurinoma of the oculomotor nerves. Apropos of 2 cases.]. Neurochirurgie 38:183187, 1992. (Fr)

    • Search Google Scholar
    • Export Citation
  • 3

    Beppu T, , Yoshida Y, , Wada T, , Arai H, , Suzuki M, & Kuroda K, et al.: Trochlear and abducens nerve neurinomas accompanied by a cerebellopontine angle meningioma—case report. Neurol Med Chir (Tokyo) 37:416421, 1997

    • Search Google Scholar
    • Export Citation
  • 4

    Celli P, , Ferrante L, , Acqui M, , Mastronardi L, , Fortuna A, & Palma L: Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. Surg Neurol 38:216224, 1992

    • Search Google Scholar
    • Export Citation
  • 5

    Chakrabarti KB, , Doughty D, & Plowman PN: Stereotactic multiple arc radiotherapy. II—Cranial neuroma. Br J Neurosurg 10:577583, 1996

  • 6

    Chen BH: Neurinoma of the abducens nerve. Neurosurgery 9:6466, 1981

  • 7

    Chen JCT, , Giannotta SL, , Yu C, , Petrovich Z, , Levy ML, & Apuzzo MLJ: Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48:10221032, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Chernov M, & DeMonte F, Skull base tumors. Levin VA: Cancer in the Nervous System ed 2 Oxford, Oxford University Press, 2002. 300319

  • 9

    Delsanti C, , Roche PH, , Thomassin JM, & Regis J, Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure. Regis J, & Roche PH: Modern Management of Acoustic Neuroma. Progress in Neurological Surgery Basel, Karger, 2008. 21:9397

    • Search Google Scholar
    • Export Citation
  • 10

    Erlich SA, , Tymianski M, & Kiehl TR: Cellular schwannoma of the abducens nerve: case report and review of the literature. Clin Neurol Neurosurg 111:467471, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Fisher LM, , Doherty JK, , Lev MH, & Slattery WH III: Distribution of nonvestibular cranial nerve schwannomas in neurofibromatosis 2. Otol Neurotol 28:10831090, 2007

    • Search Google Scholar
    • Export Citation
  • 12

    Flickinger JC, & Barker FG II: Clinical results: Radiosurgery and radiotherapy of cranial nerve schwannomas. Neurosurg Clin N Am 17:121128, vi, 2006

    • Search Google Scholar
    • Export Citation
  • 13

    Ginsberg F, , Peyster RG, , Rose WS, & Drapkin AJ: Sixth nerve schwannoma: MR and CT demonstration. J Comput Assist Tomogr 12:482484, 1988

  • 14

    Hamm KD, , Gross MW, , Fahrig A, , Surber G, , Henzel M, & Kleinert G, et al.: Stereotactic radiotherapy for the treatment of nonacoustic schwannomas. Neurosurgery 62:5 Suppl A29A36, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Hansman ML, , Hoover ED, & Peyster RG: Sixth nerve neuroma in the cavernous sinus: CT features. J Comput Assist Tomogr 10:10301032, 1986

  • 16

    Hayashi M, , Ochiai T, , Nakaya K, , Chernov M, , Tamura N, & Maruyama T, et al.: Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 105:Suppl 511, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Hayashi M, , Ochiai T, , Nakaya K, , Chernov M, , Tamura N, & Yomo S, et al.: Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg 105:Suppl 1217, 2006

    • Search Google Scholar
    • Export Citation
  • 18

    Iaconetta G, , Fusco M, , Cavallo LM, , Cappabianca P, , Samii M, & Tschabitscher M: The abducens nerve: microanatomic and endoscopic study. Neurosurgery 61:3 Suppl 714, 2007

    • Search Google Scholar
    • Export Citation
  • 19

    Ichimi K, , Yoshida J, , Inao S, & Wakabayashi T: Abducens nerve neurinoma—case report. Neurol Med Chir (Tokyo) 37:197200, 1997

  • 20

    Igaki H, , Maruyama K, , Tago M, , Shin M, , Murakami N, & Koga T, et al.: Cyst formation after stereotactic radiosurgery for intracranial meningioma. Stereotact Funct Neurosurg 86:231236, 2008

    • Search Google Scholar
    • Export Citation
  • 21

    Inoue HK, Other skull base tumors. Yamamoto M: Japanese Experience with Gamma Knife Radiosurgery Progress in Neurological Surgery Basel, Karger, 2009. 22:112121

    • Search Google Scholar
    • Export Citation
  • 22

    Irace C, , Davì G, , Corona C, , Candino M, , Usai S, & Gambacorta M: Isolated intraorbital schwannoma arising from the abducens nerve. Acta Neurochir (Wien) 150:12091210, 2008

    • Search Google Scholar
    • Export Citation
  • 23

    Ishikawa E, , Yamamoto M, , Saito A, , Kujiraoka Y, , Iijima T, & Akutsu H, et al.: Delayed cyst formation after gamma knife radiosurgery for brain metastases. Neurosurgery 65:689695, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Izawa M, , Chernov M, , Hayashi M, , Nakaya K, , Kamikawa S, & Kato K, et al.: Management and prognosis of cysts developed on long-term follow-up after Gamma Knife radiosurgery for intracranial arteriovenous malformations. Surg Neurol 68:400406, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Kato K, , Wanifuchi H, & Watanabe A: [Cyst formation after gamma knife radiosurgery for trigeminal schwannoma: a case report.]. No Shinkei Geka 37:573578, 2009. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 26

    Kim IY, , Kondziolka D, , Niranjan A, , Flickinger JC, & Lunsford LD: Gamma Knife surgery for schwannomas originating from cranial nerves III, IV, and VI. J Neurosurg 109:Suppl 149153, 2008

    • Search Google Scholar
    • Export Citation
  • 27

    Kim MS, , Park K, , Kim JH, , Kim YD, & Lee JI: Gamma knife radiosurgery for orbital tumors. Clin Neurol Neurosurg 110:10031007, 2008

  • 28

    Kondziolka D, , Flickinger JC, & Lunsford LD: The principles of skull base radiosurgery. Neurosurg Focus 24:5 E11, 2008

  • 29

    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
  • 30

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

    • Search Google Scholar
    • Export Citation
  • 31

    Lanotte M, , Giordana MT, , Forni C, & Pagni CA: Schwannoma of the cavernous sinus. Case report and review of the literature. J Neurosurg Sci 36:233238, 1992

    • Search Google Scholar
    • Export Citation
  • 32

    Leunda G, , Vaquero J, , Cabezudo J, , Garcia-Uria J, & Bravo G: Schwannoma of the oculomotor nerves. Report of four cases. J Neurosurg 57:563565, 1982

    • Search Google Scholar
    • Export Citation
  • 33

    Lo PA, , Harper CG, & Besser M: Intracavernous schwannoma of the abducens nerve: a review of the clinical features, radiology and pathology of an unusual case. J Clin Neurosci 8:357360, 2001

    • Search Google Scholar
    • Export Citation
  • 34

    Lunsford LD, , Niranjan A, , Martin JJ, , Sirin S, , Kassam A, & Kondziolka D, et al.: Radiosurgery for miscellaneous skull base tumors. Szeifert GT, , Kondziolka D, & Levivier M, et al.: Radiosurgery and Pathological Fundamentals Progress in Neurological Surgery Basel, Karger, 2007. 20:192205

    • Search Google Scholar
    • Export Citation
  • 35

    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
  • 36

    Mascarenhas L, , Magalhaes Z, , Honavar M, , Romao H, , Resende M, & Resende Pereira J, et al.: Schwannoma of the abducens nerve in the cavernous sinus. Acta Neurochir (Wien) 146:389392, 2004

    • Search Google Scholar
    • Export Citation
  • 37

    Nakagawa T, , Uchida K, , Ozveren MF, & Kawase T: Abducens schwannoma inside the cavernous sinus proper: case report. Surg Neurol 61:559563, 2004

    • Search Google Scholar
    • Export Citation
  • 38

    Nakamura M, , Carvalho GA, & Samii M: Abducens nerve schwannoma: a case report and review of the literature. Surg Neurol 57:183189, 2002

  • 39

    Nehls DG, , Sonntag VKH, , Murphy AR, , Johnson PC, & Waggener JD: Fibroblastic tumor of the abducens nerve. Case report. J Neurosurg 62:296299, 1985

    • Search Google Scholar
    • Export Citation
  • 40

    Nishioka K, , Abo D, , Aoyama H, , Furuta Y, , Onimaru R, & Onodera S, et al.: Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys 75:14151419, 2009

    • Search Google Scholar
    • Export Citation
  • 41

    Okada Y, , Shima T, , Nishida M, & Okita S: Large sixth nerve neuroma involving the prepontine region: case report. Neurosurgery 40:608610, 1997

    • Search Google Scholar
    • Export Citation
  • 42

    Park JH, , Cho YH, , Kim JH, , Lee JK, & Kim CJ: Abducens nerve schwannoma: case report and review of the literature. Neurosurg Rev 32:375378, 2009

    • Search Google Scholar
    • Export Citation
  • 43

    Pollock BE: Stereotactic radiosurgery of benign intracranial tumors. J Neurooncol 92:337343, 2009

  • 44

    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
  • 45

    Safavi-Abbasi S, , Bambakidis NC, , Zabramski JM, , Workman R, , Verma K, & Senoglu M, et al.: Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management. Acta Neurochir (Wien) 152:3546, 2010

    • Search Google Scholar
    • Export Citation
  • 46

    Sarma S, , Sekhar LN, & Schessel DA: Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery 50:437449, 2002

  • 47

    Shi X, , Han H, , Zhao J, & Zhou C: Microsurgical anatomy of the superior orbital fissure. Clin Anat 20:362366, 2007

  • 48

    Showalter TN, , Werner-Wasik M, , Curran WJ Jr, , Friedman DP, , Xu X, & Andrews DW: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery 63:734740, 2008

    • Search Google Scholar
    • Export Citation
  • 49

    Suetake K, , Kurokawa Y, , Uede T, , Momota H, & Hashi K: A case of abducens neurinoma mimicking acoustic neurinoma. Comput Med Imaging Graph 22:257261, 1998

    • Search Google Scholar
    • Export Citation
  • 50

    Tishler RB, , Loeffler JS, , Lunsford LD, , Duma C, , Alexander E III, & Kooy HM, et al.: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215221, 1993

    • Search Google Scholar
    • Export Citation
  • 51

    Tonn JC: Microneurosurgery and radiosurgery—an attractive combination. Acta Neurochir Suppl 91:103108, 2004

  • 52

    Tung H, , Chen T, & Weiss MH: Sixth nerve schwannomas. Report of two cases. J Neurosurg 75:638641, 1991

  • 53

    Türe U, , Seker A, , Kurtkaya O, & Pamir MN: Internal carotid plexus schwannoma of the cavernous sinus: case report. Neurosurgery 52:435439, 2003

    • Search Google Scholar
    • Export Citation
  • 54

    Vachata P, & Sames M: Abducens nerve schwannoma mimicking intrinsic brainstem tumor. Acta Neurochir (Wien) 151:12811287, 2009

  • 55

    Waldron JS, , Tihan T, & Parsa AT: Solitary fibrous tumor arising from Cranial Nerve VI in the prepontine cistern: case report and review of a tumor subpopulation mimicking schwannoma. Neurosurgery 59:E939E940, 2006

    • Search Google Scholar
    • Export Citation
  • 56

    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

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