• Ajay Niranjan, Andrew Faramand, Sudesh S Raju, Cheng-Chia Lee, Huai-Che Yang, Ahmed M Nabeel, Sameh R Tawadros, El-ShehabyAmr M NAMNGamma Knife Center Cairo, Cairo , Egypt.Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt., Khaled Abdelkarim, Reem M Emad, Wael A Reda, Roberto Martínez Álvarez, MorenoNuria E MartínezNEMRS Unit, Ruber International Hospital, Madrid , Spain., Roman Liscak, Jaromir May, David Mathieu, Anne-Marie Langlois, M Harrison Snyder, Matthew J Shepard, Jason Sheehan, Baha'eddin A Muhsen, Hamid Borghei-Razavi, Gene Barnett, Douglas Kondziolka, John G Golfinos, Luca Attuati, Piero Picozzi, James McInerney, Lekhaj Chand Daggubati, Ronald E Warnick, Caleb E Feliciano, Eric Carro, David McCarthy, Robert M Starke, Howard J Landy, Christopher P Cifarelli, John A Vargo, John Flickinger, and L Dade Lunsford.
• Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA.
• Neurosurgery. 2024 Jan 1; 94 (1): 165173165-173.

Background And ObjectivesAn international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma.MethodsPatient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed.ResultsThe median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%).ConclusionSRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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