Acute neurological complications following gamma knife surgery for vestibular schwannoma
Case report
Ania G. Pollack
Ania G. Pollack
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
MaryAnne H. Marymont
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
John A. Kalapurakal
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
艾伦Kepka
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
Vythialingam Sathiaseelan
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
James P. Chandler
Departments of Neurological Surgery, Northwestern University Feinberg School of Medicine; Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois
✓ The authors describe an acute facial and acoustic neuropathy following gamma knife surgery (GKS) for vestibular schwannoma (VS). This 39-year-old woman presenting with tinnitus underwent GKS for a small right-sided intracanalicular VS, receiving a maximal dose of 26 Gy and a tumor margin dose of 13 Gy to the 50% isodose line. Thirty-six hours following treatment she presented with nausea, vomiting, vertigo, diminished hearing, and a House—Brackmann Grade III facial palsy. She was started on intravenous glucocorticosteroid agents, and over the course of 2 weeks her facial function returned to House—Brackmann Grade I. Unfortunately, her hearing loss persisted. A magnetic resonance (MR) image obtained at the time of initial deterioration demonstrated a significant decrease in tumor enhancement but no change in tumor size or peritumoral edema. Subsequently, the patient experienced severe hemifacial spasms, which persisted for a period of 3 weeks and then progressed to a House—Brackmann Grade V facial palsy. During the next 3 months, the patient was treated with steroids and in time her facial function and hearing returned to baseline levels. Results of MR imaging revealed transient enlargement (3 mm) of the tumor, which subsequently returned to its baseline size. This change corresponded to the tumor volume increase from 270 to 336 mm3. The patient remains radiologically and neurologically stable at 10 months posttreatment.
This is the first detailed report of acute facial and vestibulocochlear neurotoxicity following GKS for VS that improved with time. In addition, MR imaging findings were indicative of early neurotoxic changes. A review of possible risk factors and explanations of causative mechanisms is provided.
Address reprint requests to:James P. Chandler, M.D., Department of Neurological Surgery, 676 North St. Clair Street, Suite 2210, Chicago, Illinois 60611. email:jchandler@nmff.org.
BodisS,,AlexanderEIII,,KooyH,&LoefflerJS:The prevention of radiosurgery-induced nausea and vomiting by ondansetron: evidence of a direct effect on the central nervous system chemoreceptor trigger zone.Surg Neurol42:249–252,1994Bodis S, Alexander E III, Kooy H, Loeffler JS: The prevention of radiosurgery-induced nausea and vomiting by ondansetron: evidence of a direct effect on the central nervous system chemoreceptor trigger zone.Surg Neurol 42:249–252, 1994
Bodis
S
,
Alexander
E
III
,
Kooy
H
,
Loeffler
JS
:
The prevention of radiosurgery-induced nausea and vomiting by ondansetron: evidence of a direct effect on the central nervous system chemoreceptor trigger zone.Surg Neurol
42
:
249
–
252
,
1994
Bodis S, Alexander E III, Kooy H, Loeffler JS: The prevention of radiosurgery-induced nausea and vomiting by ondansetron: evidence of a direct effect on the central nervous system chemoreceptor trigger zone.
Surg Neurol 42:249–252, 1994
10.1016/0090-3019(94)90272-0)| false
ChangSD,,PoenJ,,HancockSL,,MartinDP,&AdlerJRJr:Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases.J Neurosurg89:321–325,1998Chang SD, Poen J, Hancock SL, Martin DP, Adler JR Jr: Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases.J Neurosurg 89:321 - 325年,1998年
Chang
SD
,
Poen
J
,
Hancock
SL
,
Martin
DP
,
Adler
JR
Jr
:
Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases.J Neurosurg
89
:
321
–
325
,
1998
Chang SD, Poen J, Hancock SL, Martin DP, Adler JR Jr: Acute hearing loss following fractionated stereotactic radiosurgery for acoustic neuroma. Report of two cases.
J Neurosurg 89:321 - 325年,1998年
10.3171/jns.1998.89.2.0321)| false
FlickingerJC,,KondziolkaD,&LunsfordLD:Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery.Radiother Oncol41:215–219,1996弗里金格JC, Kondziolka D,朗斯福德LD:剂量和diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery.Radiother Oncol 41:215–219, 1996
FlickingerJC,,KondziolkaD,,PollockBE,&LunsfordLD:Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome.Int J Radiat Oncol Biol Phys36:275–280,1996Flickinger JC, Kondziolka D, Pollock BE, Lunsford LD: Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome.Int J Radiat Oncol Biol Phys 36:275–280, 1996
FlickingerJC,,LunsfordLD,,LinskeyME,,DumaCM,&KondziolkaD:Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results.Radiother Oncol27:91–98,1993Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondziolka D: Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results.Radiother Oncol 27:91–98, 1993
HellmanS:Principles of cancer management: radiation therapy, inDe VitaVTJr,,HellmanS,&RosenbergSA(eds):Cancer: Principles and Practice of Oncology,ed 5.Philadelphia:Lippincott-Raven,1997, pp307–332Hellman S: Principles of cancer management: radiation therapy, in De Vita VT Jr, Hellman S, Rosenberg SA (eds):Cancer: Principles and Practice of Oncology, ed 5.Philadelphia: Lippincott-Raven, 1997, pp 307–332
Hellman
S
:
Principles of cancer management: radiation therapy
, in
De Vita
VT
Jr
,
Hellman
S
,
Rosenberg
SA
(eds):Cancer: Principles and Practice of Oncology
,
ed 5
.
Philadelphia
:
Lippincott-Raven
,
1997
, pp
307
–
332
Hellman S: Principles of cancer management: radiation therapy, in De Vita VT Jr, Hellman S, Rosenberg SA (eds):
Cancer: Principles and Practice of Oncology, ed 5.Philadelphia: Lippincott-Raven, 1997, pp 307–332)| false
HirschA,&NorenG:Audiological findings after stereotactic radiosurgery in acoustic neurinomas.Acta Otolaryngol106:244–251,1988Hirsch A, Noren G: Audiological findings after stereotactic radiosurgery in acoustic neurinomas.Acta Otolaryngol 106:244–251, 1988
HitschkeK,,BuhlerR,,ApellHJ,&StarkG:Inactivation of the Na, K-ATPase by radiation-induced free radicals. Evidence for a radical-chain mechanism.2月列托人353:297–300,1994Hitschke K, Buhler R, Apell HJ, Stark G: Inactivation of the Na, K-ATPase by radiation-induced free radicals. Evidence for a radical-chain mechanism.2月列托人353:297–300, 1994
Hitschke
K
,
Buhler
R
,
Apell
HJ
,
Stark
G
:
Inactivation of the Na, K-ATPase by radiation-induced free radicals. Evidence for a radical-chain mechanism.2月列托人
353
:
297
–
300
,
1994
Hitschke K, Buhler R, Apell HJ, Stark G: Inactivation of the Na, K-ATPase by radiation-induced free radicals. Evidence for a radical-chain mechanism.
2月列托人353:297–300, 1994
10.1016/0014-5793(94)01067-6)| false
IkedaK,,SunoseH,&TakasakaT:Effects of free radicals on the intracellular calcium concentration in the isolated outer hair cell of the guinea pig cochlea.Acta Otolaryngol113:137–141,1993Ikeda K, Sunose H, Takasaka T: Effects of free radicals on the intracellular calcium concentration in the isolated outer hair cell of the guinea pig cochlea.Acta Otolaryngol 113:137–141, 1993
Ikeda
K
,
Sunose
H
,
Takasaka
T
:
Effects of free radicals on the intracellular calcium concentration in the isolated outer hair cell of the guinea pig cochlea.Acta Otolaryngol
113
:
137
–
141
,
1993
Ikeda K, Sunose H, Takasaka T: Effects of free radicals on the intracellular calcium concentration in the isolated outer hair cell of the guinea pig cochlea.
Acta Otolaryngol 113:137–141, 1993
10.3109/00016489309135781)| false
ItoK,,KuritaH,,SugasawaK,,OkunoT,,MizunoM,&SasakiT:Neuro-otological findings after radiosurgery for acoustic neurinomas.Arch Otolaryngol Head Neck Surg122:1229–1233,1996Ito K, Kurita H, Sugasawa K, Okuno T, Mizuno M, Sasaki T: Neuro-otological findings after radiosurgery for acoustic neurinomas.Arch Otolaryngol Head Neck Surg 122:1229–1233, 1996
Ito
K
,
Kurita
H
,
Sugasawa
K
,
Okuno
T
,
Mizuno
M
,
Sasaki
T
:
Neuro-otological findings after radiosurgery for acoustic neurinomas.Arch Otolaryngol Head Neck Surg
122
:
1229
–
1233
,
1996
Ito K, Kurita H, Sugasawa K, Okuno T, Mizuno M, Sasaki T: Neuro-otological findings after radiosurgery for acoustic neurinomas.
Arch Otolaryngol Head Neck Surg 122:1229–1233, 1996
10.1001/archotol.1996.01890230075014)| false
KobayashiT,,TanakaT,&KidaY:The early effects of gamma knife on 40 cases of acoustic neurinoma.Acta Neurochir Suppl62:93–97,1994田中小林T, T,重击Y:早期effects of gamma knife on 40 cases of acoustic neurinoma.Acta Neurochir Suppl 62:93–97, 1994
Kobayashi
T
,
Tanaka
T
,
Kida
Y
:
The early effects of gamma knife on 40 cases of acoustic neurinoma.Acta Neurochir Suppl
62
:
93
–
97
,
1994
田中小林T, T,重击Y:早期effects of gamma knife on 40 cases of acoustic neurinoma.
Acta Neurochir Suppl 62:93–97, 1994
10.1007/978-3-7091-9371-6_19)| false
LinskeyME,,LunsfordLD,&FlickingerJC:Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors.开云体育app官方网站下载入口31:829–839,1992Linskey ME, Lunsford LD, Flickinger JC: Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors.Neurosurgery 31:829–839, 1992
LinskeyME,,LunsfordLD,,FlickingerJC,&KondziolkaD:Stereotactic radiosurgery for acoustic tumors.Neurosurg Clin N Am3:191–205,1992Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D: Stereotactic radiosurgery for acoustic tumors.Neurosurg Clin N Am 3:191–205, 1992
MendenhallWM,,FriedmanWA,,BuattiJM,&BovaFJ:Preliminary results of linear accelerator radiosurgery for acoustic schwannomas.J Neurosurg85:1013–1019,1996林业局WM, Friedman WA, Buatti JM, Bova FJ: Preliminary results of linear accelerator radiosurgery for acoustic schwannomas.J Neurosurg 85:1013–1019, 1996
MillerRC,,FooteRL,,CoffeyRJ,,SargentDJ,,GormanDA,&SchombergPJ,et al:Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume.Int J Radiat Oncol Biol Phys43:305–311,1999Miller RC, Foote RL, Coffey RJ, Sargent DJ, Gorman DA, Schomberg PJ, et al: Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume.Int J Radiat Oncol Biol Phys 43:305–311, 1999
Miller
RC
,
Foote
RL
,
Coffey
RJ
,
Sargent
DJ
,
Gorman
DA
,
Schomberg
PJ
,
et al
:
Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume.Int J Radiat Oncol Biol Phys
43
:
305
–
311
,
1999
Miller RC, Foote RL, Coffey RJ, Sargent DJ, Gorman DA, Schomberg PJ, et al: Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume.
Int J Radiat Oncol Biol Phys 43:305–311, 1999
10.1016/S0360-3016(98)00397-6)| false
NakataH,,YoshimineT,,MurasawaA,,KumuraE,,HaradaK,&UshioY,et al:Early blood-brain barrier disruption after high-dose single-fraction irradiation in rats.Acta Neurochir (Wien)136:82–87,1995Nakata H, Yoshimine T, Murasawa A, Kumura E, Harada K, Ushio Y, et al: Early blood-brain barrier disruption after high-dose single-fraction irradiation in rats.Acta Neurochir (Wien) 136:82–87, 1995
Nakata
H
,
Yoshimine
T
,
Murasawa
A
,
Kumura
E
,
Harada
K
,
Ushio
Y
,
et al
:
Early blood-brain barrier disruption after high-dose single-fraction irradiation in rats.Acta Neurochir (Wien)
136
:
82
–
87
,
1995
Nakata H, Yoshimine T, Murasawa A, Kumura E, Harada K, Ushio Y, et al: Early blood-brain barrier disruption after high-dose single-fraction irradiation in rats.
Acta Neurochir (Wien) 136:82–87, 1995
10.1007/BF01411440)| false
NorenG,,ArndtJ,&HindmarshT:Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences.开云体育app官方网站下载入口13:12–22,1983Noren G, Arndt J, Hindmarsh T: Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences.Neurosurgery 13:12–22, 1983
PoenJC,,GolbyAJ,,ForsterKM,,MartinDP,,ChinnDM,&HancockSL,et al:Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report.开云体育app官方网站下载入口45:1299–1307,1999Poen JC, Golby AJ, Forster KM, Martin DP, Chinn DM, Hancock SL, et al: Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report.Neurosurgery 45:1299–1307, 1999
Poen
JC
,
Golby
AJ
,
Forster
KM
,
Martin
DP
,
Chinn
DM
,
Hancock
SL
,
et al
:
Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report.开云体育app官方网站下载入口
45
:
1299
–
1307
,
1999
Poen JC, Golby AJ, Forster KM, Martin DP, Chinn DM, Hancock SL, et al: Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report.
Neurosurgery 45:1299–1307, 1999
10.1097/00006123-199912000-00004)| false
SakamotoT,,ShiratoH,,SatoN,,KageiK,,SawamuraY,&SuzukiK,et al:Audiological assessment before and after fractionated stereotactic irradiation for vestibular schwannoma.Radiother Oncol49:185–190,1998Sakamoto T, Shirato H, Sato N, Kagei K, Sawamura Y, Suzuki K, et al: Audiological assessment before and after fractionated stereotactic irradiation for vestibular schwannoma.Radiother Oncol 49:185–190, 1998
Sakamoto
T
,
Shirato
H
,
Sato
N
,
Kagei
K
,
Sawamura
Y
,
Suzuki
K
,
et al
:
Audiological assessment before and after fractionated stereotactic irradiation for vestibular schwannoma.Radiother Oncol
49
:
185
–
190
,
1998
Sakamoto T, Shirato H, Sato N, Kagei K, Sawamura Y, Suzuki K, et al: Audiological assessment before and after fractionated stereotactic irradiation for vestibular schwannoma.
Radiother Oncol 49:185–190, 1998
10.1016/S0167-8140(98)00090-5)| false
SohmerH,&FreemanS:Functional development of auditory sensitivity in the fetus and neonate.J Basic Clin Physiol Pharmacol6:95–108,1995Sohmer H, Freeman S: Functional development of auditory sensitivity in the fetus and neonate.J Basic Clin Physiol Pharmacol 6:95–108, 1995
Sohmer
H
,
Freeman
S
:
Functional development of auditory sensitivity in the fetus and neonate.J Basic Clin Physiol Pharmacol
6
:
95
–
108
,
1995
Sohmer H, Freeman S: Functional development of auditory sensitivity in the fetus and neonate.
J Basic Clin Physiol Pharmacol 6:95–108, 1995)| false
SubachBR,,KondziolkaD,,LunsfordLD,,BissonetteDJ,,FlickingerJC,&MaitzAH:Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2.J Neurosurg90:815–822,1999Subach BR, Kondziolka D, Lunsford LD, Bissonette DJ, Flickinger JC, Maitz AH: Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2.J Neurosurg 90:815–822, 1999
TagoM,,TeraharaA,,NakagawaK,,AokiY,,OhtomoK,&ShinM,et al:Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma. Case report.J Neurosurg93(Suppl 3):78–81,2000Tago M, Terahara A, Nakagawa K, Aoki Y, Ohtomo K, Shin M, et al: Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma. Case report.J Neurosurg 93 (Suppl 3):78–81, 2000
Tago
M
,
Terahara
A
,
Nakagawa
K
,
Aoki
Y
,
Ohtomo
K
,
Shin
M
,
et al
:
Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma. Case report.J Neurosurg
93
(Suppl 3)
:
78
–
81
,
2000
Tago M, Terahara A, Nakagawa K, Aoki Y, Ohtomo K, Shin M, et al: Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma. Case report.
J Neurosurg 93 (Suppl 3):78–81, 2000
10.3171/jns.2000.93.supplement_3.0078)| false
VermeulenS,,YoungR,,PosewitzA,,GrimmP,,BlaskoJ,&KohlerE,et al:Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: the Seattle Northwest gamma knife experience.Stereotact Funct Neurosurg70(Suppl 1):80–87,1998Vermeulen S, Young R, Posewitz A, Grimm P, Blasko J, Kohler E, et al: Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: the Seattle Northwest gamma knife experience.Stereotact Funct Neurosurg 70 (Suppl 1):80–87, 1998
Vermeulen
S
,
Young
R
,
Posewitz
A
,
Grimm
P
,
Blasko
J
,
Kohler
E
,
et al
:
Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: the Seattle Northwest gamma knife experience.Stereotact Funct Neurosurg
70
(Suppl 1)
:
80
–
87
,
1998
Vermeulen S, Young R, Posewitz A, Grimm P, Blasko J, Kohler E, et al: Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: the Seattle Northwest gamma knife experience.
Stereotact Funct Neurosurg 70 (Suppl 1):80–87, 1998
10.1159/000056410)| false
Werner-Wasik
M
,
Rudoler
S
,
Preston
PE
,
Hauck
WW
,
Downes
BM
,
Leeper
D
,
et al
:
Immediate side effects of stereotactic radiotherapy and radiosurgery.Int J Radiat Oncol Biol Phys
43
:
299
–
304
,
1999
Werner-Wasik M, Rudoler S, Preston PE, Hauck WW, Downes BM, Leeper D, et al: Immediate side effects of stereotactic radiotherapy and radiosurgery.
Int J Radiat Oncol Biol Phys 43:299–304, 1999
10.1016/S0360-3016(98)00410-6)| false
YamaneH,,NakaiY,,TakayamaM,,KonishiK,,IguchiH,&NakagawaT,et al:The emergence of free radicals after acoustic trauma and strial blood flow.Acta Otolaryngol Suppl519:87–92,1995Yamane H, Nakai Y, Takayama M, Konishi K, Iguchi H, Nakagawa T, et al: The emergence of free radicals after acoustic trauma and strial blood flow.Acta Otolaryngol Suppl 519:87–92, 1995
Yamane
H
,
Nakai
Y
,
Takayama
M
,
Konishi
K
,
Iguchi
H
,
Nakagawa
T
,
et al
:
The emergence of free radicals after acoustic trauma and strial blood flow.Acta Otolaryngol Suppl
519
:
87
–
92
,
1995
Yamane H, Nakai Y, Takayama M, Konishi K, Iguchi H, Nakagawa T, et al: The emergence of free radicals after acoustic trauma and strial blood flow.
Acta Otolaryngol Suppl 519:87–92, 1995)| false
