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Gamma Knife surgery and trigeminal schwannoma: is it possible to preserve cranial nerve function?

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Issue Date
2007-10
Publisher
American Association of Neurological Surgeons
Citation
J Neurosurg 107:727–732,2007
Keywords
cranial neuropathyGamma Knife surgerytrigeminal schwannoma
Abstract
Object. The current study was undertaken to evaluate the tumor control rate and functional outcome after Gamma
Knife surgery (GKS) in patients with a trigeminal schwannoma. The conditions associated with the development of cranial
neuropathies after radiosurgery were scrutinized.
Methods. The authors reviewed the clinical records and radiological data in 22 consecutive patients who received
GKS for a trigeminal schwannoma. The median tumor volume was 4.1 ml (0.2–12.0 ml), and the mean tumor margin
dose was 13.3 6 1.3 Gy at an isodose line of 49.9 6 0.6% (mean 6 standard deviation). The median clinical followup
period was 46 months (range 24–89 months), and the median length of imaging follow-up was 37 months (range
24–79 months).
Results. Tumor growth control was achieved in 21 (95%) of the 22 patients. Facial pain responded best to radiosurgery,
with two thirds of patients showing improvement. However, only one third of patients with facial hypesthesia
improved. Six patients (27%) experienced new or worsening cranial neuropathies after GKS. Ten patients (46%)
showed tumor expansion after radiosurgery, and nine of these also showed central enhancement loss. Loss of central
enhancement, tumor expansion, and a tumor in a cavernous sinus were found to be significantly related to the emergence
of cranial neuropathies.
Conclusions. The use of GKS to treat trigeminal schwannoma resulted in a high rate of tumor control and functional
improvement. Cranial neuropathies are bothersome complications of radiosurgery, and tumor expansion in a cavernous
sinus after radiosurgery appears to be the proximate cause of the complication. Loss of central enhancement
could be used as a warning sign of cranial neuropathies, and for this vigilant patient monitoring is required.
ISSN
0022-3085
Language
English
URI
https://hdl.handle.net/10371/74209
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College of Medicine/School of Medicine (의과대학/대학원)Neurosurgery (신경외과학전공)Journal Papers (저널논문_신경외과학전공)
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