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Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management

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Abstract

Purpose

Nonvestibular cranial nerve schwannomas (NVCNS) are relatively rare tumors. We evaluated our experience with radiosurgical and microsurgical treatment alone and in combination for the management of NVCNS.

Methods

The charts of 62 patients with NVCNS who were treated between 1993 and 2005 at our institution were reviewed. Patients diagnosed with neurofibromatosis type 2 were excluded. The patients underwent microsurgery and/or radiosurgery treatment.

Results

Trigeminal and jugular foramen schwannomas were the most common NVCNS tumors (n = 47), and the only two groups with sufficient numbers of patients to allow comparison of the three treatment approaches. In these two groups, the mean tumor volume was significantly higher in those who received combined therapy (8.59 ± 2.29 cc), compared with radiosurgery (4.94 ± 3.02 cc; p = 0.05) or microsurgery alone (5.38 ± 3.23; p = 0.027). Patients who underwent radiosurgery alone were significantly older (67.7 ± 13.3 years; p = 0.019) than those treated with microsurgery (55.3 ± 13.7 years) or with both modalities (48.7 ± 12.8 years). The Karnofsky Performance Scale scores were significantly higher (p ≤ 0.05) at follow-up compared with baseline for all three treatment approaches. There was no significant change in the Glasgow Outcome scores before and after treatment.

Conclusions

Microsurgery and radiosurgery can both be used to manage NVCNS tumors with excellent results. When treatment with either modality alone is not reasonable, tumors can be managed effectively with combined micro- and radiosurgery treatment.

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Author information

Author notes

  1. Sam Safavi-Abbasi

    Present address: Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA

  2. Nicholas C. Bambakidis

    Present address: Department of Neurological Surgery, Case Medical Center, University Hospitals of Cleveland, Cleveland, OH, USA

Authors and Affiliations

  1. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Joseph M. Zabramski, Randall W. Porter & Robert F. Spetzler

  2. Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Ryan Workman, Ketan Verma & Mehmet Senoglu

  3. c/o Neuroscience Publications, Barrow Neurological Institute, 350 W. Thomas Road, Phoenix, AZ, 85013, USA

    Nicholas C. Bambakidis

Authors
  1. Sam Safavi-Abbasi
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Corresponding author

Correspondence to Nicholas C. Bambakidis.

Additional information

Comment

The authors present 62 patients with non-vestibular schwannomas treated at their institution with a combination of microsurgery and/or radiosurgery. The material includes a wide range of management tactics, surgical approaches and radiation dosages and protocols. The results are reassuringly and reproducibly good.

The authors give a logical account of the reasons why their management paradigms have changed over the years, coming away from major "heroic" microsurgical operations in favour of utilising radiosurgery alone or following microsurgery. This is in keeping with the trend worldwide, driven by the very real morbidity caused by cranial nerve deficits. They also point out the limitations of "minimally invasive" radiosurgical approaches when one faces very large tumours.

It is undoubtedly the case that not all neurosurgical departments engaged in skull base microsurgery can achieve the excellent results of the best. Therefore, it will be only natural that in various departments the indication for utilising one or other modality or indeed their combination will be different. Also, skull base surgeons will have to balance dealing with these complicated neoplasms in their own unit or referring them to centres of excellence where expertise of all intervention modalities will be readily available.

Andras Kemeny

Sheffield, UK

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Safavi-Abbasi, S., Bambakidis, N.C., Zabramski, J.M. et al. Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management. Acta Neurochir 152, 35–46 (2010). https://doi.org/10.1007/s00701-009-0403-5

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