Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 12/2017

01-12-2017 | Original Article - Functional

Radiosurgery in trochlear and abducens nerve schwannomas: case series and systematic review

Authors: Iulia Peciu-Florianu, Constantin Tuleasca, Jean-Nicolas Comps, Luis Schiappacasse, Michele Zeverino, Roy Thomas Daniel, Marc Levivier

Published in: Acta Neurochirurgica | Issue 12/2017

Login to get access

Abstract

Introduction

Schwannomas involving the occulomotor cranial nerves  (CNs; III, IV and VI), can be disabling, due to the associated diplopia and decreased quality of life and are extremely rare. We evaluated the role of Gamma Knife surgery (GKS) in these cases.

Methods

Five patients with CN IV and VI schwannomas (three and two, respectively) were treated in Lausanne University Hospital between 2010 and 2015. Four benefitted from upfront GKS and one from a combined approach (planned subtotal resection followed by GKS), due to a large preoperative tumour volume (size, 3 × 2 × 2.5 cm; volume, 7.9 ml), with symptomatic mass effect and oedema, as well as an entrapement cyst at the brainstem interface, in a young patient. Neuro-ophtalmological evaluation was performed at baseline and during each follow-up time-point. A systematic literature review is presented and compared to the present report.

Results

The mean follow-up was 44.4 months (12–54). Initial clinical presentation was diplopia in four cases and cavernous sinus syndrome in one. The marginal dose was 12 Gy in all cases. The mean target volume was 1.51 cm3 (0.086–5.8). The mean prescription isodose volume (PIV) was 1.71 cm3 (0.131–6.7). At last follow-up, all patients presented with disappearance of the baseline symptoms. Tumour control was achieved in 100%, with decrease in volume in all cases. The systematic review analysed 11 peer-reviewed studies, with a total of 35 patients. For uniformly reported CN VI, the mean marginal radiation dose ranged between 12 and 12.5 Gy, with disappearance of symptoms in 12.5%, improvement in 31.25%, stabilisation in 6.25%, worsening in 12.5%. Tumour volume decreased in all cases.

Conclusions

Our data suggest that first intention GKS is a safe and effective option for patients with small to medium size oculomotor schwannomas, providing a high rate of clinical alleviation and tumour control. When the initial tumour volume is too large for first intention GKS, a combined approach with planned subtotal resection followed by GKS can be performed, with favourable and comparable outcomes as in upfront GKS.
Literature
1.
Acharya R, Husain S, Chhabra SS, Patir R, Bhalla S, Seghal AD (2003) Sixth nerve schwannoma: a case report with literature review. Neurol Sci 24:74–79PubMed
2.
Asaoka K, Sawamura Y, Murai H, Satoh M (1999) Schwannoma of the oculomotor nerve: a case report with consideration of the surgical treatment. Neurosurgery 45:630–633 discussion 633-634CrossRefPubMed
3.
Barat JL, Marchal JC, Bracard S, Auque J, Martin-Beuzart S, Hepner H (1992) Neurinoma of the oculomotor nerves. Apropos of 2 cases. Neurochirurgie 38:183–187PubMed
4.
Beppu T, Yoshida Y, Wada T, Arai H, Suzuki M, Kuroda K, Ogawa A (1997) Trochlear and abducens nerve neurinomas accompanied by a cerebellopontine angle meningioma—case report. Neurol Med Chir (Tokyo) 37:416–421CrossRef
5.
Boucher AB, Michael LM 2nd (2014, 2014) The middle fossa approach for the removal of a trochlear schwannoma. Case Rep Neurol Med:672314
6.
Celli P, Ferrante L, Acqui M, Mastronardi L, Fortuna A, Palma L (1992) Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. Surg Neurol 38:216–224CrossRefPubMed
7.
Chakrabarti KB, Doughty D, Plowman PN (1996) Stereotactic multiple arc radiotherapy. II—Cranial neuroma. Br J Neurosurg 10:577–583CrossRefPubMed
8.
9.
Choi CY, Soltys SG, Gibbs IC, Harsh GR, Sakamoto GT, Patel DA, Lieberson RE, Chang SD, Adler JR (2011) Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery. Neurosurgery 68:1200–1208 discussion 1208CrossRefPubMed
10.
Chowdhury FH, Haque MR, Kawsar KA, Sarker MH, Hasan M, Goel AH (2014) Intracranial nonvestibular neurinomas: Young neurosurgeons’ experience. J Neurosci Rural Pract 5:231–243CrossRefPubMedPubMedCentral
11.
Daniel RT, Tuleasca C, Messerer M, Negretti L, George M, Pasche P, Levivier M (2013) Minimally invasive skull base surgery: principles and practice. Nova Publishers, New York
12.
Daniel RT, Tuleasca C, George M, Pralong E, Schiappacasse L, Zeverino M, Maire R, Levivier M (2017) Preserving normal facial nerve function and improving hearing outcome in large vestibular schwannomas with a combined approach: planned subtotal resection followed by gamma knife radiosurgery. Acta Neurochir 159:1197–1211CrossRefPubMedPubMedCentral
13.
Deruty R, Guyotat J, Mottolese C, Bady B, Madoux MG, Vighetto A, Vila A (1988) Partial recovery of the oculomotor nerve after section and repair during the excision of a tumor. Neurochirurgie 34:287–292PubMed
14.
Elflein HM, Thomke F, Muller-Forell W, Pitz S (2010) Trochlear palsies caused by isolated trochlear schwannomas. Strabismus 18:83–86CrossRefPubMed
15.
Elmalem VI, Younge BR, Biousse V, Leavitt JA, Moster ML, Warner J, Kupersmith MJ, Landau K, Brodsky MC, Frohman LP, May EF, Tomsak RL, Newman NJ (2009) Clinical course and prognosis of trochlear nerve schwannomas. Ophthalmology 116:2011–2016CrossRefPubMed
16.
Elsharkawy M, Xu Z, Schlesinger D, Sheehan JP (2012) Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes. J Neurosurg 116:66–72CrossRefPubMed
17.
Erlich SA, Tymianski M, Kiehl TR (2009) Cellular schwannoma of the abducens nerve: case report and review of the literature. Clin Neurol Neurosurg 111:467–471CrossRefPubMed
18.
Ginsberg F, Peyster RG, Rose WS, Drapkin AJ (1988) Sixth nerve schwannoma: MR and CT demonstration. J Comput Assist Tomogr 12:482–484CrossRefPubMed
19.
Haselsberger K, Maier T, Dominikus K, Holl E, Kurschel S, Ofner-Kopeinig P, Unger F (2009) Staged gamma knife radiosurgery for large critically located benign meningiomas: evaluation of a series comprising 20 patients. J Neurol Neurosurg Psychiatry 80:1172–1175CrossRefPubMed
20.
Hatae R, Miyazono M, Kohri R, Maeda K, Naito S (2014) Trochlear nerve schwannoma with intratumoral hemorrhage presenting with persistent hiccups: a case report. J Neurol Surg Rep 75:e183–e188CrossRefPubMedPubMedCentral
21.
Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Yomo S, Izawa M, Hori T, Takakura K, Regis J (2006) Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg 105(Suppl):12–17PubMed
22.
Hayashi M, Chernov M, Tamura N, Yomo S, Ochiai T, Nagai M, Tamura M, Izawa M, Muragaki Y, Iseki H, Okada Y, Takakura K (2010) Gamma Knife surgery for abducent nerve schwannoma. Report of 4 cases. J Neurosurg 113(Suppl):136–143PubMed
23.
Ichimi K, Yoshida J, Inao S, Wakabayashi T (1997) Abducens nerve neurinoma—case report. Neurol Med Chir (Tokyo) 37:197–200CrossRef
24.
Inoue T, Shima A, Hirai H, Suzuki F, Matsuda M (2015) Trochlear nerve schwannoma treated with Gamma Knife after excision: a case report and review of the literature. J Neurol Surg Rep 76:e248–e252CrossRefPubMedPubMedCentral
25.
Irace C, Davi G, Corona C, Candino M, Usai S, Gambacorta M (2008) Isolated intraorbital schwannoma arising from the abducens nerve. Acta Neurochir 150:1209–1210CrossRefPubMed
26.
Iwabuchi T, Suzuki M, Nakaoka T, Suzuki S (1982) Oculomotor nerve anastomosis. Neurosurgery 10:490–491CrossRefPubMed
27.
Kim IY, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2008) Gamma Knife surgery for schwannomas originating from cranial nerves III, IV, and VI. J Neurosurg 109(Suppl):149–153PubMed
28.
Kim R, Kim JH, Kim E, Yang HK, Hwang JM, Kim JS (2015) Oculomotor nerve tumors masquerading as recurrent painful ophthalmoplegic neuropathy: report of two cases and review of the literature. Cephalalgia 35:825–830CrossRefPubMed
29.
Kimball MM, Foote KD, Bova FJ, Chi YY, Friedman WA (2011) Linear accelerator radiosurgery for nonvestibular schwannomas. Neurosurgery 68:974–984 discussion 984CrossRefPubMed
30.
Korchi AM, Cuvinciuc V, Caetano J, Becker M, Lovblad KO, Vargas MI (2014) Imaging of the cavernous sinus lesions. Diagn Interv Imaging 95:849–859CrossRefPubMed
31.
Kumar LP, Monica I, Uppin MS, Kotiyala VJ (2014) Large oculomotor nerve schwannoma--rare entity: a case report with review of literature. J Cancer Res Ther 10:1098–1100CrossRefPubMed
32.
Lanotte M, Giordana MT, Forni C, Pagni CA (1992) Schwannoma of the cavernous sinus. Case report and review of the literature. J Neurosurg Sci 36:233–238PubMed
33.
Leavitt JA, Stafford SL, Link MJ, Pollock BE (2013) Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 87:524–527CrossRefPubMed
34.
Leunda G, Vaquero J, Cabezudo J, Garcia-Uria J, Bravo G (1982) Schwannoma of the oculomotor nerves. Report of four cases. J Neurosurg 57:563–565CrossRefPubMed
35.
Lo PA, Harper CG, Besser M (2001) Intracavernous schwannoma of the abducens nerve: a review of the clinical features, radiology and pathology of an unusual case. J Clin Neurosci 8:357–360CrossRefPubMed
36.
Lunardi P, Rocchi G, Rizzo A, Missori P (1990) Neurinoma of the oculomotor nerve. Clin Neurol Neurosurg 92:333–335CrossRefPubMed
37.
Mascarenhas L, Magalhaes Z, Honavar M, Romao H, Resende M, Resende Pereira J, Rocha Vaz A (2004) Schwannoma of the abducens nerve in the cavernous sinus. Acta Neurochir 146:389–392 discussion 391-382CrossRefPubMed
38.
Mehta VS, Singh RV, Misra NK, Choudhary C (1990) Schwannoma of the oculomotor nerve. Br J Neurosurg 4:69–72CrossRefPubMed
39.
Mindermann T, Schlegel I (2014) How to distinguish tumor growth from transient expansion of vestibular schwannomas following Gamma Knife radiosurgery. Acta Neurochir 156:1121–1123CrossRefPubMed
40.
Moses JE, Vermani N, Bansal SK (2011) Preoperative clinico-radiological diagnosis of schwannoma arising from cavernous segment of abducens nerve. Neurol India 59:471–473CrossRefPubMed
41.
Nakagawa T, Uchida K, Ozveren MF, Kawase T (2004) Abducens schwannoma inside the cavernous sinus proper: case report. Surg Neurol 61:559–563 discussion 563CrossRefPubMed
42.
Nakamura M, Carvalho GA, Samii M (2002) Abducens nerve schwannoma: a case report and review of the literature. Surg Neurol 57:183–188 discussion 188-189CrossRefPubMed
43.
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 75:1415–1419CrossRefPubMed
44.
Okada Y, Shima T, Nishida M, Okita S (1997) Large sixth nerve neuroma involving the prepontine region: case report. Neurosurgery 40:608–610PubMed
45.
46.
Park JH, Cho YH, Kim JH, Lee JK, Kim CJ (2009) Abducens nerve schwannoma: case report and review of the literature. Neurosurg Rev 32:375–378 discussion 378CrossRefPubMed
47.
Pendl G, Unger F, Papaefthymiou G, Eustacchio S (2000) Staged radiosurgical treatment for large benign cerebral lesions. J Neurosurg 93(Suppl 3):107–112PubMed
48.
Petrela E, Hodge CJ, Hahn SS, Chung CT, Mejico LJ (2009) Stereotactic radiosurgery in two cases of presumed fourth cranial nerve schwannoma. J Neuroophthalmol 29:54–57CrossRefPubMed
49.
Pollock BE, Foote RL, Stafford SL (2002) Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys 52:1002–1007CrossRefPubMed
50.
Pollock BE, Link MJ, Leavitt JA, Stafford SL (2014) Dose-volume analysis of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Neurosurgery 75:456–460 discussion 460CrossRefPubMed
51.
52.
Prasad GL, Sharma MS, Kale SS, Agrawal D, Singh M, Sharma BS (2016) Gamma Knife radiosurgery in the treatment of abducens nerve schwannomas: a retrospective study. J Neurosurg:1–6
53.
Razek AA, Castillo M (2009) Imaging lesions of the cavernous sinus. AJNR Am J Neuroradiol 30:444–452CrossRefPubMed
54.
Samii M, Gerganov VM, Samii A (2010) Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 112:860–867CrossRefPubMed
55.
Sekhar LN, Lanzino G, Sen CN, Pomonis S (1992) Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery. J Neurosurg 76:935–943CrossRefPubMed
56.
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 740CrossRefPubMed
57.
Sirin S, Kondziolka D, Niranjan A, Flickinger JC, Maitz AH, Lunsford LD (2008) Prospective staged volume radiosurgery for large arteriovenous malformations: indications and outcomes in otherwise untreatable patients. Neurosurgery 62(Suppl 2):744–754PubMed
58.
Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J (2006) The natural history of vestibular schwannoma. Otol Neurotol 27:547–552PubMed
59.
Suetake K, Kurokawa Y, Uede T, Momota H, Hashi K (1998) A case of abducens neurinoma mimicking acoustic neurinoma. Comput Med Imaging Graph 22:257–261CrossRefPubMed
60.
Takano S, Endo M, Miyasaka Y, Yada K, Ohwada T, Takagi H (1990) Neurinoma of the oculomotor nerve—case report. Neurol Med Chir (Tokyo) 30:132–136CrossRef
61.
Tanriover N, Kemerdere R, Kafadar AM, Muhammedrezai S, Akar Z (2007) Oculomotor nerve schwannoma located in the oculomotor cistern. Surg Neurol 67:83–88 discussion 88CrossRefPubMed
62.
Tos M, Stangerup SE, Caye-Thomasen P, Tos T, Thomsen J (2004) What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130:216–220CrossRefPubMed
63.
Tung H, Chen T, Weiss MH (1991) Sixth nerve schwannomas. Report of two cases. J Neurosurg 75:638–641CrossRefPubMed
64.
Vachata P, Sames M (2009) Abducens nerve schwannoma mimicking intrinsic brainstem tumor. Acta Neurochir 151:1281–1287CrossRefPubMed
65.
van de Langenberg R, Hanssens PE, van Overbeeke JJ, Verheul JB, Nelemans PJ, de Bondt BJ, Stokroos RJ (2011) Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 115:875–884CrossRefPubMed
Metadata
Title
Radiosurgery in trochlear and abducens nerve schwannomas: case series and systematic review
Authors
Iulia Peciu-Florianu
Constantin Tuleasca
Jean-Nicolas Comps
Luis Schiappacasse
Michele Zeverino
Roy Thomas Daniel
Marc Levivier
Publication date
01-12-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3348-0

Other articles of this Issue 12/2017

Acta Neurochirurgica 12/2017 Go to the issue

Original Article - Spine

Patients’ beliefs about diagnosis and treatment of cervical spondylosis with radiculopathy

Editorial

Cerebral microdialysis in TBI—limitations and possibilities

Technical Note - Neurosurgical Techniques

Affordable self-regulating irrigation device for microsurgery using readily available malleable wire and a Silastic tube: a technical note

Correction

Correction to:“Careful” reprogramming of baclofen intrathecal programmable synchromed infusion pumps at their replacement in a series of 156 patients

How I Do it - Spine

Is the complete excision of circumferential intradural spinal meningiomas achievable?

Original Article - Functional

Amygdalohippocampotomy for mesial temporal lobe sclerosis: Epilepsy outcome 5 years after surgery