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Acta Neurochirurgica

, Volume 160, Issue 5, pp 987–996 | Cite as

Upfront Gamma Knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review

  • Jean-Nicolas Comps
  • Constantin Tuleasca
  • Beatrice Goncalves-Matoso
  • Luis Schiappacasse
  • Maud Marguet
  • Marc Levivier
Original Article - Functional

Abstract

Introduction

Facial nerve schwannomas are rare tumors and account for less than 2% of intracranial neurinomas, despite being the most common tumors of the facial nerve. The optimal management is currently under debate and includes observation, microsurgical resection, radiosurgery (RS), and fractionated radiotherapy. Radiosurgery might be a valuable alternative, as a minimally invasive technique, in symptomatic patients and/or presenting tumor growth.

Methods

We review our series of four consecutive cases, treated with Gamma Knife surgery (GKS) between July 2010 and July 2017 in Lausanne University Hospital, Switzerland. Clinical and dosimetric parameters were assessed. Radiosurgery was performed using Leksell Gamma Knife Perfexion. We additionally performed a systematic review, which included 23 articles and 193 treated patients from the current literrature.

Results

The mean age at the time of the GKS was 44.25 years (median 43.5, range 34–56). Mean follow-up period was 31.8 months (median 36, range 3–60). Two cases presented with facial palsy and other two with hemifacial spasm. Pretherapeutically, House–Brackmann (HB) grade was II for one case, III for two, and VI for one. The mean gross tumor volume (GTV) was 0.406 ml (median 0.470 ml, range 0.030–0.638 ml). The mean marginal prescribed dose was 12 Gy at the mean 54% isodose line (median 50%, range 50–70). The mean prescription isodose volume (PIV) was 0.510 ml (median 0.596 ml, range 0.052–0.805 ml). The mean dose received by the cochlea was 4.2 Gy (median 4.1 Gy, range 0.1–10). One patient benefited from a staged-volume GKS. At last follow-up, tumor volume was stable in one and decreased in three cases. Facial palsy remained stable in two patients (one HB II and one HB III) and improved in two (from HB III to II and from HB VI to HB III). Regarding hemifacial spasm, both patients presenting one pretherapeutically had a decrease in its frequency and intensity after GKS. All patients kept stable Gardner–Robertson class 1 at last follow-up.

Conclusion

In our experience, RS and particularly GKS, using standard, yet low doses of radiation, appear to be a safe and effective therapeutic option in the management of these rare tumors. The results as from our systematic review are also encouraging with satisfactory rates of clinical stabilization and/or improvement and high rate of tumor control. Complications are infrequent and mostly transient.

Keywords

Radiosurgery Gamma Knife surgery Facial Schwannoma Palsy Systematic review 

Notes

Acknowledgments

Lausanne University Hospital.

Funding information

Lausanne University Hospital.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

For this type of study, no ethical committee approval is necessary. The patients agree to the publication of the clinical image, in the present format.

References

  1. 1.
    Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, Werner-Wasik M, Rosenstock J, Curran WJ Jr (2001) Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:1265–1278CrossRefPubMedGoogle Scholar
  2. 2.
    Chan AW, Black P, Ojemann RG, Barker FG 2nd, Kooy HM, Lopes VV, McKenna MJ, Shrieve DC, Martuza RL, Loeffler JS (2005) Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 57:60–70 discussion 60-70CrossRefPubMedGoogle Scholar
  3. 3.
    Channer GA, Herman B, Telischi FF, Zeitler D, Angeli SI (2012) Management outcomes of facial nerve tumors: comparative outcomes with observation, CyberKnife, and surgical management. Otolaryngol Head Neck Surg 147:525–530CrossRefPubMedGoogle Scholar
  4. 4.
    Chen MC, Tseng TM, Hung SH, Chen PY (2014) Facial nerve schwannoma: a case report and review of the literature. Oncol Lett 8:2787–2789CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Collen C, Ampe B, Gevaert T, Moens M, Linthout N, De Ridder M, Verellen D, D’Haens J, Storme G (2011) Single fraction versus fractionated linac-based stereotactic radiotherapy for vestibular schwannoma: a single-institution experience. Int J Radiat Oncol Biol Phys 81:e503–e509CrossRefPubMedGoogle Scholar
  6. 6.
    Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL (2015) Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas—pooled results from 3 large German centers. Radiother Oncol 114:378–383CrossRefPubMedGoogle Scholar
  7. 7.
    Cuneo KC, Zagar TM, Brizel DM, Yoo DS, Hoang JK, Chang Z, Wang Z, Yin FF, Das SK, Green S, Ready N, Bhatti MT, Kaylie DM, Becker A, Sampson JH, Kirkpatrick JP (2012) Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves. Technol Cancer Res Treat 11:221–228CrossRefPubMedGoogle Scholar
  8. 8.
    Fezeu F, Lee CC, Dodson BK, Mukherjee S, Przybylowski CJ, Awad AJ, Xu Z, Ball BZ, Basuel D, Schlesinger D, Sheehan JP (2015) Stereotactic radiosurgery for facial nerve schwannomas: a preliminary assessment and review of the literature. Br J Neurosurg 29:213–218CrossRefPubMedGoogle Scholar
  9. 9.
    Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97:55–66CrossRefPubMedGoogle Scholar
  10. 10.
    Hasegawa T (2013) Stereotactic radiosurgery for nonvestibular schwannomas. Neurosurg Clin N Am 24:531–542CrossRefPubMedGoogle Scholar
  11. 11.
    Hasegawa T, Kato T, Kida Y, Hayashi M, Tsugawa T, Iwai Y, Sato M, Okamoto H, Kano T, Osano S, Nagano O, Nakazaki K (2016) Gamma knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan. J Neurosurg 124:403–410CrossRefPubMedGoogle Scholar
  12. 12.
    Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T (2011) Factors associated with hearing preservation after gamma knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 115:1078–1086CrossRefPubMedGoogle Scholar
  13. 13.
    House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147CrossRefPubMedGoogle Scholar
  14. 14.
    Jacob JT, Driscoll CL, Link MJ (2012) Facial nerve schwannomas of the cerebellopontine angle: the mayo clinic experience. J Neurol Surg B Skull Base 73:230–235CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Janecka IP, Conley J (1987) Primary neoplasms of the facial nerve. Plast Reconstr Surg 79:177–185CrossRefPubMedGoogle Scholar
  16. 16.
    Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433CrossRefPubMedGoogle Scholar
  17. 17.
    Kopp C, Fauser C, Muller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL (2011) Stereotactic fractionated radiotherapy and LINAC radiosurgery in the treatment of vestibular schwannoma-report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys 80:1485–1491CrossRefPubMedGoogle Scholar
  18. 18.
    Lee MS, Penumala S, Sweet S, De Luca RR, Stearnes AE, Akgun Y (2017) Long-term progression of sensorineural hearing loss and tinnitus after combined intensity-modulated radiation therapy and cisplatin-based chemotherapy for nasopharyngeal carcinoma: a case report. Case Rep Oncol 10:743–751CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lee SH, Choi HJ, Choi SK, Lim YJ (2014) Unusual acute hearing loss after gamma knife surgery for a facial schwannoma. Acta Neurochir 156:397–401 discussion 401CrossRefPubMedGoogle Scholar
  20. 20.
    Litre CF, Gourg GP, Tamura M, Roche PH, Regis J (2008) Gamma knife surgery for facial nerve schwannomas. Prog Neurol Surg 21:131–135CrossRefPubMedGoogle Scholar
  21. 21.
    Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D (2005) Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102(Suppl):195–199CrossRefGoogle Scholar
  22. 22.
    Madhok R, Kondziolka D, Flickinger JC, Lunsford LD (2009) Gamma knife radiosurgery for facial schwannomas. Neurosurgery 64:1102–1105 discussion 1105CrossRefPubMedGoogle Scholar
  23. 23.
    Massager N, Nissim O, Delbrouck C, Delpierre I, Devriendt D, Desmedt F, Wikler D, Brotchi J, Levivier M (2007) Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 107:733–739CrossRefPubMedGoogle Scholar
  24. 24.
    Massager N, Nissim O, Delbrouck C, Delpierre I, Devriendt D, Desmedt F, Wikler D, Brotchi J, Levivier M (2013) Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 119(Suppl):733–739PubMedGoogle Scholar
  25. 25.
    McClelland S 3rd, Dusenbery KE, Higgins PD, Hall WA (2007) Treatment of a facial nerve neuroma with fractionated stereotactic radiotherapy. Stereotact Funct Neurosurg 85:299–302CrossRefPubMedGoogle Scholar
  26. 26.
    McRackan TR, Wilkinson EP, Brackmann DE, Slattery WH (2015) Stereotactic radiosurgery for facial nerve schwannomas: meta-analysis and clinical review. Otol Neurotol 36:393–398CrossRefPubMedGoogle Scholar
  27. 27.
    Mdarhri D, Touzani A, Tamura M, Regis J (2004) Gamma knife surgery for VII nerve schwannomas. Neuro-Chirurgie 50:407–413PubMedGoogle Scholar
  28. 28.
    Meijer OW, Vandertop WP, Baayen JC, Slotman BJ (2003) Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396CrossRefPubMedGoogle Scholar
  29. 29.
    Moon JH, Chang WS, Jung HH, Lee KS, Park YG, Chang JH (2014) Gamma knife surgery for facial nerve schwannomas. J Neurosurg 121 Suppl:116–122PubMedGoogle Scholar
  30. 30.
    Nishioka K, Abo D, Aoyama H, Furuta Y, Onimaru R, Onodera S, Sawamura Y, Ishikawa M, Fukuda S, Shirato H (2009) Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys 75:1415–1419CrossRefPubMedGoogle Scholar
  31. 31.
    Pollock BE, Foote RL, Stafford SL (2002) Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys 52:1002–1007CrossRefPubMedGoogle Scholar
  32. 32.
    Puataweepong P, Dhanachai M, Hansasuta A, Saetia K, Dangprasert S, Sitathanee C, Yongvithisatid P (2016) Clinical outcomes of intracranial nonvestibular schwannomas treated with LinacBased stereotactic radiosurgery and radiotherapy. Asian Pac J Cancer Prev 17:3271–3276PubMedGoogle Scholar
  33. 33.
    Sheehan JP, Kano H, Xu Z, Chiang V, Mathieu D, Chao S, Akpinar B, Lee JY, Yu JB, Hess J, Wu HM, Chung WY, Pierce J, Missios S, Kondziolka D, Alonso-Basanta M, Barnett GH, Lunsford LD (2015) Gamma knife radiosurgery for facial nerve schwannomas: a multicenter study. J Neurosurg 123:387–394CrossRefPubMedGoogle Scholar
  34. 34.
    Shi W, Jain V, Kim H, Champ C, Jain G, Farrell C, Andrews DW, Judy K, Liu H, Artz G, Werner-Wasik M, Evans JJ (2016) Fractionated stereotactic radiotherapy for facial nerve schwannomas. J Neurol Surg B Skull Base 77:75–80PubMedGoogle Scholar
  35. 35.
    Shirato H, Sakamoto T, Takeichi N, Aoyama H, Suzuki K, Kagei K, Nishioka T, Fukuda S, Sawamura Y, Miyasaka K (2000) Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): comparison between cystic-type and solid-type VS. Int J Radiat Oncol Biol Phys 48:1395–1401CrossRefPubMedGoogle Scholar
  36. 36.
    Showalter TN, Werner-Wasik M, Curran WJ Jr, Friedman DP, Xu X, Andrews DW (2008) Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery 63:734–740 discussion 740CrossRefPubMedGoogle Scholar
  37. 37.
    Tsao MN, Sahgal A, Xu W, De Salles A, Hayashi M, Levivier M, Ma L, Martinez R, Regis J, Ryu S, Slotman BJ, Paddick I (2017) Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. J Radiosurg SBRT 5:5–24PubMedPubMedCentralGoogle Scholar
  38. 38.
    Tuleasca C, George M, Faouzi M, Schiappacasse L, Leroy HA, Zeverino M, Daniel RT, Maire R, Levivier M (2016) Acute clinical adverse radiation effects after gamma knife surgery for vestibular schwannomas. J Neurosurg 125:73–82PubMedGoogle Scholar
  39. 39.
    Wilkinson EP, Hoa M, Slattery WH 3rd, Fayad JN, Friedman RA, Schwartz MS, Brackmann DE (2011) Evolution in the management of facial nerve schwannoma. Laryngoscope 121:2065–2074CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neurosciences Department, Neurosurgery Service and Gamma Knife CenterLausanne University Hospital (CHUV)LausanneSwitzerland
  2. 2.Faculty of Biology and MedicineUniversity of LausanneLausanneSwitzerland
  3. 3.Swiss Federal Institute of Technology, Signal Processing Laboratory (LTS5)LausanneSwitzerland
  4. 4.ENT DepartmentLausanne University Hospital (CHUV)LausanneSwitzerland
  5. 5.Radiotherapy DepartmentLausanne University HospitalLausanneSwitzerland
  6. 6.Institute of Radiation Physics LausanneLausanneSwitzerland

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