Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

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  • 1 Department of Neurosurgery, Komaki City Hospital, Komaki;
  • 2 Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya;
  • 3 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo;
  • 4 Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya;
  • 5 Department of Neurosurgery, Osaka City General Hospital, Osaka;
  • 6 Department of Neurosurgery, Kitanihon Neurosurgical Hospital, Gosen;
  • 7 Department of Neurosurgery, Takashima Hospital, Yonago;
  • 8 Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki;
  • 9 Department of Neurosurgery, Shonan Fujisawa Tokushukai Hospital, Fujisawa;
  • 10 Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara; and
  • 11 Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Japan
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OBJECT

The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs).

METHODS

This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm3, and the median prescription dose to the tumor margin was 12 Gy.

RESULTS

The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing.

CONCLUSIONS

GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.

ABBREVIATIONSCPA = cerebellopontine angle; FNS = facial nerve schwannoma; GKS = Gamma Knife surgery; HB = House-Brackmann; PTA = pure tone average; SRS = stereotactic radiosurgery.

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Contributor Notes

Correspondence Toshinori Hasegawa, Department of Neurosurgery, Komaki City Hospital, Gamma Knife Center, 1-20 Jobushi, Komaki, Aichi Prefecture 485-8520, Japan. email: h-toshi@komakihp.gr.jp.

INCLUDE WHEN CITING Published online September 11, 2015; DOI: 10.3171/2015.3.JNS142677.

Disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Brown M, , Ruckenstein M, , Bigelow D, , Judy K, , Wilson V, & Alonso-Basanta M, : Predictors of hearing loss after Gamma Knife radiosurgery for vestibular schwannomas: age, cochlear dose, and tumor coverage. Neurosurgery 69:605614, 2011

    • Search Google Scholar
    • Export Citation
  • 2

    Choi CYH, , Soltys SG, , Gibbs IC, , Harsh GR, , Sakamoto GT, & Patel DA, : Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery. Neurosurgery 68:12001208, 2011

    • Search Google Scholar
    • Export Citation
  • 3

    Elsharkawy M, , Xu Z, , Schlesinger D, & Sheehan JP: Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes. J Neurosurg 116:6672, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Falcioni M, , Russo A, , Taibah A, & Sanna M: Facial nerve tumors. Otol Neurotol 24:942947, 2003

  • 5

    Hasegawa T: Stereotactic radiosurgery for nonvestibular schwannomas. Neurosurg Clin N Am 24:531542, 2013

  • 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, , Kato T, , Iizuka H, , Kuramitsu S, & Yamamoto T: Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557565, 2013

    • Search Google Scholar
    • Export Citation
  • 8

    Hasegawa T, , Kida Y, , Kato T, , Iizuka H, & Yamamoto T: Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 115:10781086, 2011

    • Search Google Scholar
    • Export Citation
  • 9

    Hayashi M, , Chernov MF, , Lipski SM, , Tamura N, , Yomo S, & Horiba A, : Do we really still need an open surgery for treatment of patients with vestibular schwannomas?. Acta Neurochir Suppl 116:2536, 2013

    • Search Google Scholar
    • Export Citation
  • 10

    Hayden Gephart MG, , Hansasuta A, , Balise RR, , Choi C, , Sakamoto GT, & Venteicher AS, : Cochlea radiation dose correlates with hearing loss after stereotactic radiosurgery of vestibular schwannoma. World Neurosurg 80:359363, 2013

    • Search Google Scholar
    • Export Citation
  • 11

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146147, 1985

  • 12

    Iwai Y, , Yamanaka K, , Shiotani M, & Uyama T: Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282288, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Jacob JT, , Carlson ML, , Schiefer TK, , Pollock BE, , Driscoll CL, & Link MJ: Significance of cochlear dose in the radiosurgical treatment of vestibular schwannoma: controversies and unanswered questions. Neurosurgery 74:466474, 2014

    • Search Google Scholar
    • Export Citation
  • 14

    Jacob JT, , Driscoll CLW, & Link MJ: Facial nerve schwannomas of the cerebellopontine angle: the mayo clinic experience. J Neurol Surg B Skull Base 73:230235, 2012

    • Search Google Scholar
    • Export Citation
  • 15

    Kano H, , Kondziolka D, , Khan A, , Flickinger JC, & Lunsford LD: Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 111:863873, 2009

    • Search Google Scholar
    • Export Citation
  • 16

    Kertesz TR, , Shelton C, , Wiggins RH, , Salzman KL, , Glastonbury CM, & Harnsberger R: Intratemporal facial nerve neuroma: anatomical location and radiological features. Laryngoscope 111:12501256, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Kida Y, , Yoshimoto M, & Hasegawa T: Radiosurgery for facial schwannoma. J Neurosurg 106:2429, 2007

  • 18

    Kimball MM, , Foote KD, , Bova FJ, , Chi Y-Y, & Friedman WA: Linear accelerator radiosurgery for nonvestibular schwannomas. Neurosurgery 68:974984, 2011

    • Search Google Scholar
    • Export Citation
  • 19

    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
  • 20

    Li Y, , Liu H, & Cheng Y: Subtotal resection of facial nerve schwannoma is not safe in the long run. Acta Otolaryngol 134:433436, 2014

  • 21

    Litre CF, , Gourg GP, , Tamura M, , Mdarhri D, , Touzani A, & Roche PH, : Gamma Knife surgery for facial nerve schwannomas. Neurosurgery 60:853859, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    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
  • 23

    McMonagle B, , Al-Sanosi A, , Croxson G, & Fagan P: Facial schwannoma: results of a large case series and review. J Laryngol Otol 122:11391150, 2008

    • Search Google Scholar
    • Export Citation
  • 24

    McRackan TR, , Rivas A, , Wanna GB, , Yoo MJ, , Bennett ML, & Dietrich MS, : Facial nerve outcomes in facial nerve schwannomas. Otol Neurotol 33:7882, 2012. (Erratum in Otol Neurotol 33:472, 2012)

    • Search Google Scholar
    • Export Citation
  • 25

    Murphy ES, , Barnett GH, , Vogelbaum MA, , Neyman G, , Stevens GH, & Cohen BH, : Long-term outcomes of Gamma Knife radiosurgery in patients with vestibular schwannomas. J Neurosurg 114:432440, 2011

    • Search Google Scholar
    • Export Citation
  • 26

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

    • Search Google Scholar
    • Export Citation
  • 27

    Ozmen OA, , Falcioni M, , Lauda L, & Sanna M: Outcomes of facial nerve grafting in 155 cases: predictive value of history and preoperative function. Otol Neurotol 32:13411346, 2011

    • Search Google Scholar
    • Export Citation
  • 28

    Shirazi MA, , Leonetti JP, , Marzo SJ, & Anderson DE: Surgical management of facial neuromas: lessons learned. Otol Neurotol 28:958963, 2007

    • Search Google Scholar
    • Export Citation
  • 29

    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
  • 30

    Wilkinson EP, , Hoa M, , Slattery WH III, , Fayad JN, , Friedman RA, & Schwartz MS, : Evolution in the management of facial nerve schwannoma. Laryngoscope 121:20652074, 2011

    • Search Google Scholar
    • Export Citation
  • 31

    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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