Gamma Knife surgery for abducent nerve schwannoma

Report of 4 cases

Restricted access

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.
Article Information

Contributor Notes

Address correspondence to: Motohiro Hayashi, M.D., D.Med.Sci., Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. email: GKRmoto@aol.com.
Headings
References
  • 1

    Acharya RHusain SChhabra SSPatir RBhalla SSeghal AD: Sixth nerve schwannoma: a case report with literature review. Neurol Sci 24:74792003

    • Search Google Scholar
    • Export Citation
  • 2

    Barat JLMarchal JCBracard SAuque JMartin-Beuzart SHepner H: [Neurinoma of the oculomotor nerves. Apropos of 2 cases.]. Neurochirurgie 38:1831871992. (Fr)

    • Search Google Scholar
    • Export Citation
  • 3

    Beppu TYoshida YWada TArai HSuzuki MKuroda K: Trochlear and abducens nerve neurinomas accompanied by a cerebellopontine angle meningioma—case report. Neurol Med Chir (Tokyo) 37:4164211997

    • Search Google Scholar
    • Export Citation
  • 4

    Celli PFerrante LAcqui MMastronardi LFortuna APalma L: Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. Surg Neurol 38:2162241992

    • Search Google Scholar
    • Export Citation
  • 5

    Chakrabarti KBDoughty DPlowman PN: Stereotactic multiple arc radiotherapy. II—Cranial neuroma. Br J Neurosurg 10:5775831996

  • 6

    Chen BH: Neurinoma of the abducens nerve. Neurosurgery 9:64661981

  • 7

    Chen JCTGiannotta SLYu CPetrovich ZLevy MLApuzzo MLJ: Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48:102210322001

    • Search Google Scholar
    • Export Citation
  • 8

    Chernov MDeMonte FSkull base tumors. Levin VA: Cancer in the Nervous System ed 2OxfordOxford University Press2002. 300319

  • 9

    Delsanti CRoche PHThomassin JMRegis JMorphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure. Regis JRoche PH: Modern Management of Acoustic Neuroma. Progress in Neurological Surgery BaselKarger2008. 21:9397

    • Search Google Scholar
    • Export Citation
  • 10

    Erlich SATymianski MKiehl TR: Cellular schwannoma of the abducens nerve: case report and review of the literature. Clin Neurol Neurosurg 111:4674712009

    • Search Google Scholar
    • Export Citation
  • 11

    Fisher LMDoherty JKLev MHSlattery WH III: Distribution of nonvestibular cranial nerve schwannomas in neurofibromatosis 2. Otol Neurotol 28:108310902007

    • Search Google Scholar
    • Export Citation
  • 12

    Flickinger JCBarker FG II: Clinical results: Radiosurgery and radiotherapy of cranial nerve schwannomas. Neurosurg Clin N Am 17:121128vi2006

    • Search Google Scholar
    • Export Citation
  • 13

    Ginsberg FPeyster RGRose WSDrapkin AJ: Sixth nerve schwannoma: MR and CT demonstration. J Comput Assist Tomogr 12:4824841988

  • 14

    Hamm KDGross MWFahrig ASurber GHenzel MKleinert G: Stereotactic radiotherapy for the treatment of nonacoustic schwannomas. Neurosurgery 62:5 SupplA29A362008

    • Search Google Scholar
    • Export Citation
  • 15

    Hansman MLHoover EDPeyster RG: Sixth nerve neuroma in the cavernous sinus: CT features. J Comput Assist Tomogr 10:103010321986

  • 16

    Hayashi MOchiai TNakaya KChernov MTamura NMaruyama T: Current treatment strategy for vestibular schwannoma: image-guided robotic microradiosurgery. J Neurosurg 105:Suppl5112006

    • Search Google Scholar
    • Export Citation
  • 17

    Hayashi MOchiai TNakaya KChernov MTamura NYomo S: Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg 105:Suppl12172006

    • Search Google Scholar
    • Export Citation
  • 18

    Iaconetta GFusco MCavallo LMCappabianca PSamii MTschabitscher M: The abducens nerve: microanatomic and endoscopic study. Neurosurgery 61:3 Suppl7142007

    • Search Google Scholar
    • Export Citation
  • 19

    Ichimi KYoshida JInao SWakabayashi T: Abducens nerve neurinoma—case report. Neurol Med Chir (Tokyo) 37:1972001997

  • 20

    Igaki HMaruyama KTago MShin MMurakami NKoga T: Cyst formation after stereotactic radiosurgery for intracranial meningioma. Stereotact Funct Neurosurg 86:2312362008

    • Search Google Scholar
    • Export Citation
  • 21

    Inoue HKOther skull base tumors. Yamamoto M: Japanese Experience with Gamma Knife Radiosurgery Progress in Neurological Surgery BaselKarger2009. 22:112121

    • Search Google Scholar
    • Export Citation
  • 22

    Irace CDavì GCorona CCandino MUsai SGambacorta M: Isolated intraorbital schwannoma arising from the abducens nerve. Acta Neurochir (Wien) 150:120912102008

    • Search Google Scholar
    • Export Citation
  • 23

    Ishikawa EYamamoto MSaito AKujiraoka YIijima TAkutsu H: Delayed cyst formation after gamma knife radiosurgery for brain metastases. Neurosurgery 65:6896952009

    • Search Google Scholar
    • Export Citation
  • 24

    Izawa MChernov MHayashi MNakaya KKamikawa SKato K: Management and prognosis of cysts developed on long-term follow-up after Gamma Knife radiosurgery for intracranial arteriovenous malformations. Surg Neurol 68:4004062007

    • Search Google Scholar
    • Export Citation
  • 25

    Kato KWanifuchi HWatanabe A: [Cyst formation after gamma knife radiosurgery for trigeminal schwannoma: a case report.]. No Shinkei Geka 37:5735782009. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 26

    Kim IYKondziolka DNiranjan AFlickinger JCLunsford LD: Gamma Knife surgery for schwannomas originating from cranial nerves III, IV, and VI. J Neurosurg 109:Suppl1491532008

    • Search Google Scholar
    • Export Citation
  • 27

    Kim MSPark KKim JHKim YDLee JI: Gamma knife radiosurgery for orbital tumors. Clin Neurol Neurosurg 110:100310072008

  • 28

    Kondziolka DFlickinger JCLunsford LD: The principles of skull base radiosurgery. Neurosurg Focus 24:5E112008

  • 29

    Kondziolka DNathoo NFlickinger JCNiranjan AMaitz AHLunsford LD: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:8158222003

    • Search Google Scholar
    • Export Citation
  • 30

    Kuo JSChen JCTYu CZelman VGiannotta SLPetrovich Z: Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:138513942004

    • Search Google Scholar
    • Export Citation
  • 31

    Lanotte MGiordana MTForni CPagni CA: Schwannoma of the cavernous sinus. Case report and review of the literature. J Neurosurg Sci 36:2332381992

    • Search Google Scholar
    • Export Citation
  • 32

    Leunda GVaquero JCabezudo JGarcia-Uria JBravo G: Schwannoma of the oculomotor nerves. Report of four cases. J Neurosurg 57:5635651982

    • Search Google Scholar
    • Export Citation
  • 33

    Lo PAHarper CGBesser M: Intracavernous schwannoma of the abducens nerve: a review of the clinical features, radiology and pathology of an unusual case. J Clin Neurosci 8:3573602001

    • Search Google Scholar
    • Export Citation
  • 34

    Lunsford LDNiranjan AMartin JJSirin SKassam AKondziolka D: Radiosurgery for miscellaneous skull base tumors. Szeifert GTKondziolka DLevivier M: Radiosurgery and Pathological Fundamentals Progress in Neurological Surgery BaselKarger2007. 20:192205

    • Search Google Scholar
    • Export Citation
  • 35

    Mabanta SRBuatti JMFriedman WAMeeks SLMendenhall WMBova FJ: Linear accelerator radiosurgery for nonacoustic schwannomas. Int J Radiat Oncol Biol Phys 43:5455481999

    • Search Google Scholar
    • Export Citation
  • 36

    Mascarenhas LMagalhaes ZHonavar MRomao HResende MResende Pereira J: Schwannoma of the abducens nerve in the cavernous sinus. Acta Neurochir (Wien) 146:3893922004

    • Search Google Scholar
    • Export Citation
  • 37

    Nakagawa TUchida KOzveren MFKawase T: Abducens schwannoma inside the cavernous sinus proper: case report. Surg Neurol 61:5595632004

    • Search Google Scholar
    • Export Citation
  • 38

    Nakamura MCarvalho GASamii M: Abducens nerve schwannoma: a case report and review of the literature. Surg Neurol 57:1831892002

  • 39

    Nehls DGSonntag VKHMurphy ARJohnson PCWaggener JD: Fibroblastic tumor of the abducens nerve. Case report. J Neurosurg 62:2962991985

    • Search Google Scholar
    • Export Citation
  • 40

    Nishioka KAbo DAoyama HFuruta YOnimaru ROnodera S: Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys 75:141514192009

    • Search Google Scholar
    • Export Citation
  • 41

    Okada YShima TNishida MOkita S: Large sixth nerve neuroma involving the prepontine region: case report. Neurosurgery 40:6086101997

    • Search Google Scholar
    • Export Citation
  • 42

    Park JHCho YHKim JHLee JKKim CJ: Abducens nerve schwannoma: case report and review of the literature. Neurosurg Rev 32:3753782009

    • Search Google Scholar
    • Export Citation
  • 43

    Pollock BE: Stereotactic radiosurgery of benign intracranial tumors. J Neurooncol 92:3373432009

  • 44

    Pollock BEFoote RLStafford SL: Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?. Int J Radiat Oncol Biol Phys 52:100210072002

    • Search Google Scholar
    • Export Citation
  • 45

    Safavi-Abbasi SBambakidis NCZabramski JMWorkman RVerma KSenoglu M: Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management. Acta Neurochir (Wien) 152:35462010

    • Search Google Scholar
    • Export Citation
  • 46

    Sarma SSekhar LNSchessel DA: Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery 50:4374492002

  • 47

    Shi XHan HZhao JZhou C: Microsurgical anatomy of the superior orbital fissure. Clin Anat 20:3623662007

  • 48

    Showalter TNWerner-Wasik MCurran WJ JrFriedman DPXu XAndrews DW: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery 63:7347402008

    • Search Google Scholar
    • Export Citation
  • 49

    Suetake KKurokawa YUede TMomota HHashi K: A case of abducens neurinoma mimicking acoustic neurinoma. Comput Med Imaging Graph 22:2572611998

    • Search Google Scholar
    • Export Citation
  • 50

    Tishler RBLoeffler JSLunsford LDDuma CAlexander E IIIKooy HM: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:2152211993

    • Search Google Scholar
    • Export Citation
  • 51

    Tonn JC: Microneurosurgery and radiosurgery—an attractive combination. Acta Neurochir Suppl 91:1031082004

  • 52

    Tung HChen TWeiss MH: Sixth nerve schwannomas. Report of two cases. J Neurosurg 75:6386411991

  • 53

    Türe USeker AKurtkaya OPamir MN: Internal carotid plexus schwannoma of the cavernous sinus: case report. Neurosurgery 52:4354392003

    • Search Google Scholar
    • Export Citation
  • 54

    Vachata PSames M: Abducens nerve schwannoma mimicking intrinsic brainstem tumor. Acta Neurochir (Wien) 151:128112872009

  • 55

    Waldron JSTihan TParsa 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:E939E9402006

    • Search Google Scholar
    • Export Citation
  • 56

    Zabel ADebus JThilmann CSchlegel WWannenmacher M: Management of benign cranial nonacoustic schwannomas by fractionated stereotactic radiotherapy. Int J Cancer 96:3563622001

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 113 111 13
Full Text Views 93 56 0
PDF Downloads 100 50 0
EPUB Downloads 0 0 0
PubMed
Google Scholar