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Stereotactic radiosurgery for the treatment of hypoglossal schwannoma: a multi-institutional retrospective study

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background

Surgical removal has been performed as the first line treatment for symptomatic or enlarging hypoglossal schwannomas (HS). Stereotactic radiosurgery (SRS) offers a minimally invasive approach that may afford long-term tumor control for patients with HS particularly those who refuse or are unfit for surgery. This study evaluates outcomes after SRS performed for both newly diagnosed and residual tumors after incomplete resection.

Methods

This retrospective, multi-institutional study involved patients treated with adjuvant or primary SRS for HS. The study end-points included local tumor response, clinical outcomes, and procedure-related complications. All the patients had Gamma Knife SRS.

Results

The cohort included 12 patients (five females), median age at SRS 49.5 years (range, 37–76)]. The median tumor target volume was 5.9 cm3 (range, 0.7–27.23). At median imaging follow-up of 37 months (range, 6–153), tumor control was achieved in 11 patients. Tumor enlargement that was managed with surgical resection was noted at the 6-month follow-up in one patient. At median clinical follow-up of 30.5 months (range, 6–157), stability, or improvement of all pre-SRS signs and symptoms was noted in nine patients. Two patients experienced worsening of at least one pre-existing symptoms or sign. New-onset trapezius weakness was noted in one patient and tongue atrophy in two patients.

Conclusion

Single-fraction SRS appears to be a safe and effective upfront and adjuvant treatment option for HS. SRS may be recommended as an alternative to surgery for patients presenting with HS or as an adjuvant treatment following subtotal resection and at HS recurrence.

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Availability of data and materials

All the participating centers obtained approval for this study and for the sharing of de-identified data with the IRRF coordinating office by the local institutional review boards.

Abbreviations

CN:

Cranial nerve

CT:

Computed tomography

GTR:

Gross total resection

HS:

Hypoglossal schwannoma

IRRF:

International Radiosurgery Research Foundation

MRI:

Magnetic resonance imaging

NF-2:

Neurofibromatosis 2

RANO:

Response assessment in neuro-oncology

SNHL:

Sensorineural hearing loss

SRS:

Stereotactic radiosurgery

SRT:

Stereotactic radiotherapy

VS:

Vestibular schwannoma

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Nisha Dabhi, Stylianos Pikis, Georgios Mantziaris & Jason P. Sheehan

  2. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi

  3. Gamma Knife Center, The Jewish Hospital, Cincinnati, OH, USA

    Ronald Warnick

  4. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey

    Selcuk Peker & Yavuz Samanci

  5. Department of Neurosurgery, New York University Langone, New York, NY, USA

    Assaf Berger & Douglas Kondziolka

  6. Department of Radiation Oncology, New York University Langone, New York, NY, USA

    Kenneth Bernstein

  7. Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Ajay Niranjan & L. Dade Lunsford

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  1. Nisha Dabhi
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Contributions

ND, SP, GM, MT, RW, SP, YS, AB, KB, DK, AN, LDL, and JPS were involved in the collection of data. ND, SP, and JS were major contributors in writing the manuscript. SP and JS critically reviewed the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason P. Sheehan.

Ethics declarations

Ethics approval and consent to participate

IRRF approved this study.

Competing interests

LDL is a stockholder in AB Elekta. RW is an honorarium for participation on the Novalis Circle Expert Board. There are no other disclosures.

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Comments

Hypoglossal schwannomas is a rare disease with little evidence regarding safety efficacy of primary or adjuvant SRS. Large cohort of vestibular schwannomas evaluated on the long term after SRS are demonstrating an excellent safety efficacy comparing favorably to microsurgical resection in the best hands [1, 2]. Microsurgical resection may be sometimes troublesome with functional risks, including risk of severe lethal dysphagia [3]. Thus, it is sensible to question the role of SRS in hypoglossal schwannomas. At last follow-up, Dahbi et al. are reporting only rare minor side effects. Interestingly, they observed resolution or improvement of pre-SRS symptoms in 4 and 7 patients, respectively, in a population of 12 patients.

As acknowledged by the authors, this series is suffering due to its retrospective nature, small size, absence of histological confirmation, and short follow-up for some of the patients. However, based on this series in patients with small middle-size hypoglossal schwannomas demonstrating no brainstem compression SRS can be proposed upfront or after previous microsurgical resection with an advantageous safety efficacy ratio.

Jean Régis, Pierre Hughes Roche.

Marseille, France.

This article is part of the Topical Collection on Tumor – Schwannoma

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Dabhi, N., Pikis, S., Mantziaris, G. et al. Stereotactic radiosurgery for the treatment of hypoglossal schwannoma: a multi-institutional retrospective study. Acta Neurochir 164, 2473–2481 (2022). https://doi.org/10.1007/s00701-022-05187-w

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  • DOI: https://doi.org/10.1007/s00701-022-05187-w

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