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J Neurol Surg B Skull Base 2024; 85(01): 075-080
DOI: 10.1055/a-1990-2861
Original Article

Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol

Sam Dayawansa 
1   Department of Neurosurgery, University of Virginia Gamma Knife Surgery Center, Charlottesville, Virginia, United States
,
Chloe Dumot
2   Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
,
Georgios Mantziaris
2   Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
,
Gautam U. Mehta 
3   Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
4   Department of Neurological Surgery, Charlottesville, Virginia, United States
,
Gregory P. Lekovic
3   Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
5   Department of Neurosurgery, House Clinic, Los Angeles, California, United States
,
Douglas Kondziolka
6   Department of Neurosurgery, New York University Medical Center, New York, New York, United States
,
David Mathieu 
7   Department of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
,
Wael A. Reda
8   Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
9   Department of Neurosurgery, Ain Shams University, Cairo, Egypt
,
Roman Liscak
10   Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
,
Lee Cheng-chia
11   Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan
12   Department of Neurosurgery, National Yang-Ming University, Hsinchu, Taiwan
,
Anthony M. Kaufmann
13   Univ Manitoba, Winnipeg, Manitoba, Canada
,
Gene Barnet
14   Department of Neuro Oncology, Cleveland Clinic, Cleveland, Ohio, United States
,
Daniel M. Trifiletti 
15   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
,
L Dade Lunsford
16   Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Jason Sheehan
2   Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
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Abstract

Background Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect.

Objective This article evaluates outcomes of patients treated with SRS versus resection + SRS.

Method We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection + SRS. The primary study outcome was unfavorable combined endpoint, defined as worsening or new clinical symptoms, and/or tumor radiological progression. SRS (38.81 ± 5.3) and resection + SRS (67.14 ± 11.8) groups had similar clinical follow-ups.

Results At the time of SRS, the tumor volumes of SRS (mean ± standard error; 1.83 ± 0.35 mL) and resection + SRS (2.51 ± 0.75 mL) groups were similar. SRS (12.15 ± 0.08 Gy) and resection + SRS (12.16 ± 0.14 Gy) groups received similar radiation doses. SRS group (42/43, 98%) had better local tumor control than the resection + SRS group (10/12, 83%, p = 0.04). Most of SRS (32/43, 74%) and resection + SRS (10/12, 83%) group patients reached a favorable combined endpoint following SRS (p = 0.52). Considering surgical associated side effects, only 2/10 patients of the resection + SRS group reached a favorable endpoint (p < 0.001).

Patients of SRS group, who are > 34 years old (p = 0.02), have larger tumors (> 4 mL, 0.04), internal auditory canal (IAC) segment tumor involvement (p = 0.01) were more likely to reach an unfavorable endpoint. Resection + SRS group patients did not show such a difference.

Conclusion While resection is still needed for larger tumors, SRS offers better clinical and radiological outcomes compared to resection followed by SRS for facial schwannomas. Younger age, smaller tumors, and non-IAC situated tumors are factors that portend a favorable outcome.

Keywords

facial nerve - schwannoma - stereotactic radiosurgery - internal auditory canal


Publication History

Received: 27 August 2022

Accepted: 24 November 2022

Accepted Manuscript online:
30 November 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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