Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies |
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| Affiliation: | 1. Department of Neurosurgery, University Hospital Zurich and University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland;2. Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland;3. Gamma Knife Center Krefeld, Krefeld, Germany;1. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA;2. Department of Orthopedic Surgery, FLH Hospitals, Geneva, NY, USA;3. Department of Orthopedic Surgery, Crouse Hospital, Syracuse, NY, USA;1. Department of Neurology, University of Missouri in Columbia, Five Hospital Drive CE 537 DC 047.00, Columbia, MO 65212, USA;2. Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA;1. Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;2. Oklahoma Comprehensive Brain Tumor Center, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Blvd., Suite 4000, Oklahoma City, OK, USA;1. Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA;2. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA;3. Harvard Medical School, Boston, MA, USA;4. Department of Neurosurgery, Stanford University, Palo Alto, CA, USA;5. University of Tokyo Hospital, Tokyo, Japan;6. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA;1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;2. Clinical Engineer Section, Clinical Support Department, Hiroshima University Hospital, Hiroshima, Japan |
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| Abstract: | We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48 hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6 days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema. |
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| Keywords: | Gamma Knife radiosurgery MRI Necrosis Vestibular schwannoma |
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