Multimodal treatment in large Schwannomas

Abstract

Authors analyze a 59 patients case series with stage III and IV schwannomas treated in our hospital between 16.11.2004-16.05.2007 with a combined method: microsurgery for massive intratumoral debulking and gamma-knife radio surgery for the tumor remnants. They were recorded 3 cases of trigeminal schwannomas, 2 cases with facial schwannomas and 50 cases with acoustic-vestibular schwannomas. 4 cases presented Neurofibromatosis type2, with bilateral schwannomas. Peak of age was 37 years (median), and the time for follow up was 11 months (median), but with a low rate of presentation for controls. No deceased or supplementary permanent morbidity was recorded in this interval of follow up. Timing between surgery and gamma knife radiotherapy was between 4 to 6 months. Our results indicate a decrease of the remnant tumor volume with 10% at 6 months after operation and radiotherapy, and with 40% after 12 months. 4 cases developed complications due to intratumoral necrosis, trigeminal neuralgia, peritumoral cyst development, which were solved by a new operation or by conservative treatment. Conclusion. Massive intratumoral debulking by open surgery, followed by gamma-knife radio surgery is a reliable option for short and long-term tumor control in the cases of large schwannomas.

Keywords

• acoustic schwannoma
• open surgery
• gamma-knife radio surgery
• results