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Early life-threating enlargement of a vestibular schwannoma after gamma knife radiosurgery

  • Case Report - Tumor - Schwannoma
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Abstract

Stereotactic gamma knife radiosurgery (GKS) may induce a transient enlargement of vestibular schwannomas (VS). This phenomenon, known as pseudoprogression or swelling, starts at about 3 months following GKS, peaks at about 6 months, and typically subsides thereafter, usually without significant neurological deterioration. We describe a 34-year-old female who developed an aggressive enlargement of a VS 1 month after GKS. The patient was treated with an immediate external ventricular drainage and surgical resection via retrosigmoid approach for an acute neurological deterioration due to hydrocephalus and brainstem compression. Histopathological examination revealed a VS with abundant intratumoral thrombosis and necrosis, suggesting that its rapid expansion could be related to massive radiation-induced tumor necrosis. The present case indicated that rapid life-threating enlargement of a VS may occur as an early complication following GKS.

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Authors and Affiliations

  1. Department of Biomedical, Metabolic and Neural Sciences, Neurosurgery Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

    Davide Nasi, Annette Puzzolante, Elisa Moriconi & Giacomo Pavesi

  2. Anatomic Pathology Unit, Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

    Elena Zunarelli

Authors
  1. Davide Nasi
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  2. Elena Zunarelli
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  3. Annette Puzzolante
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  4. Elisa Moriconi
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  5. Giacomo Pavesi
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Correspondence to Davide Nasi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee (Poznan University of Medical Sciences’ bioethics committee, approval no. 152/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Nasi, D., Zunarelli, E., Puzzolante, A. et al. Early life-threating enlargement of a vestibular schwannoma after gamma knife radiosurgery. Acta Neurochir 162, 1977–1982 (2020). https://doi.org/10.1007/s00701-020-04434-2

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  • DOI: https://doi.org/10.1007/s00701-020-04434-2

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