Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study.

BACKGROUND AND OBJECTIVES: An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS: Patient 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. RESULTS: The 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%). CONCLUSION: SRS 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.

Neurosurgery Technical Procedure: Surgeon's Position during Microscopic Transsphenoidal Surgery.

The surgeon's position in relation to the patient has been modified throughout the years for transsphenoidal surgery (TSS). Nowadays, if a microscopic approach is used, most centers place the surgeon at the side of the patient's head with the patient facing him. In this paper, we propose a more ergonomic and time-proven setup for this type of surgery. Since the early 1980s, our neurosurgical section has been using an approach where the surgeon stands behind the patient's head with the microscope tower on the surgeon's back. This position is rarely mentioned in the literature. We want to refresh this position for those who still use the microscope and those young neurosurgeons and residents who do most of their work endoscopically. We consider that when the surgeon is standing behind the patient's head, it is more comfortable for the surgeon. Also, it allows for the assistant to be close enough to help during the surgery. This technical note may bring new ideas for those using the microscopic TSS.

Prolactinoma with extensive amyloid deposits: a case report.

Prolactinomas are common benign pituitary neoplasms. Amyloid deposits are rare findings that have been reported in pituitary neoplasms. We report a case of a 48-year old man with a diagnosis of prolactinoma with extensive amyloid deposition. To our knowledge, this is the first case of amyloid in a pituitary neoplasm at our institution.