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Cent Eur Neurosurg 2010; 71(1): 35-38
DOI: 10.1055/s-0029-1225326
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Contrast Enhancement and Histopathological Findings in Vestibular Schwannoma

C. Scheller1 , S. Rampp1 , J. C. Rachinger1 , J. Prell1 , S. Koesling2 , S. Becker3 , C. Strauss1
  • 1Department of Neurosurgery, University of Halle-Wittenberg, Halle (Saale), Germany
  • 2Department of Neuroradiology, University of Halle-Wittenberg, Halle (Saale), Germany
  • 3Department of Pathology, University of Halle-Wittenberg, Halle (Saale), Germany
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Publication History

Publication Date:
20 November 2009 (online)

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Abstract

Changes of contrast uptake are considered to indicate the efficacy of therapy in irradiated vestibular schwannomas. We present a case of a large vestibular schwannoma with heterogeneous contrast uptake on MRI. Using neuronavigation, histological samples were obtained during surgery from an area with homogeneous contrast uptake and from a central tumor portion without contrast enhancement on MRI. Intraoperative investigation found no evidence of necrotic tumor, and histopathological examination revealed an active tumor in both sections, with no central necrosis. This finding illustrates the surgical experience that “necrotic tumor areas” on MRI may not be consistent with intraoperative findings. Lack of contrast uptake in previously irradiated schwannomas may not be indicative of effective radiotherapy.

Key words

contrast enhancement - radiotherapy - vestibular schwannoma - histology

References

  • 1 Anonymous . Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology – Head and Neck Surgery Foundation, INC.  Otolaryngol Head Neck Surg. 1995;  113 179-180
    Google Scholar
  • 2 Bertalanffy A, Dietrich W, Aichholzer M. et al . Gamma knife radiosurgery of acoustic neurinomas.  Acta Neurochir. 2001;  143 689-695
    Google Scholar
  • 3 Bischoff B, Romstöck J, Fahlbusch R. et al . Intraoperative BAEP pattern and perioperative vasoactive treatment for hearing preservation in vestibular schwannoma surgery.  170-175 Epub 2007 Jun 19 
    Google Scholar
  • 4 Chung WY, Liu KD, Shiau CY. et al . Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases.  J Neurosurg. 2005;  102 87-96
    Google Scholar
  • 5 Flickinger JC, Kondziolka D, Lunsford LD. Dose and diameter relationships for facial trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery.  Radiother Oncol. 1996;  41 215-219
    Google Scholar
  • 6 Foote RL, Coffey RJ, Swanson JW. et al . Stereotactic radiosurgery using the gamma knife for acoustic neuromas.  Int J Radiat Oncol Biol Phys. 1995;  32 1153-1160
    Google Scholar
  • 7 Forster DMC, Kemeny AA, Pathak A. et al . Radiosurgery: a minimally interventional alternative to microsurgery in the management of acoustic neuroma.  Br J Neurosurg. 1996;  10 169-174
    Google Scholar
  • 8 Ganslandt o, Fahrig A, Strauss C. Hemorrhage into cystic vestibular schwannoma following stereotactic radiation therapy.  Zentralbl Neurochir. 2008;  69 204-206
    Google Scholar
  • 9 Hasegawa T, Fujitani S, Katsumata S. et al . Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years.  Neurosurgery. 2005;  57 257-265
    Google Scholar
  • 10 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol.  Head Neck Surg. 1985;  93 146-147
    Google Scholar
  • 11 Iwai Y, Yamanaka K, Yamagata K. et al . Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings.  Neurosurgery. 2007;  60 75-82
    Google Scholar
  • 12 Kobayashi T, Tanaka T, Kida Y. The early effects of gamma knife on 40 cases of acoustic neuroma.  Acta Neurochir. ((Suppl)) 1994;  62 93-97
    Google Scholar
  • 13 Kondziolka D, Lunsford LD, McLaughlin MR. et al . Long-term outcomes after radiosurgery for acoustic neuromas.  N Engl J Med. 1998;  339 1426-1433
    Google Scholar
  • 14 Kwon Y, Khang SK, Kim CJ. et al . Radiologic and histopathologic changes after gamma knife radiosurgery for acoustic schwannoma.  Stereotact Funct Neurosurg. 1999;  72 2-10
    Google Scholar
  • 15 Leksell L. A note on the treatment of acoustic tumours.  Acta Chir Scand. 1971;  136 763-765
    Google Scholar
  • 16 Levivier M, Massager N, David P. In vivo evaluation of tumor response to radiosurgery: application to vestibular schwannomas.  Neurochirurgie. 2004;  50 320-326
    Google Scholar
  • 17 Lunsford LD, Niranjan A, Flickinger JC. et al . Radiosurgery of vestibular schwannomas: summary of experience in 829 cases.  J Neurosurg. 2005;  102 195-199
    Google Scholar
  • 18 Mendenhall WM, Friedman WA, Buatti JM. et al . Preliminary results of linear accelerator radiosurgery for acoustic schwannomas.  J Neurosurg. 1996;  85 1013-1019
    Google Scholar
  • 19 Nakamura H, Jokura H, Takahashi K. et al . Serial follow-up MR imaging after gamma knife radiosurgery for vestibular schwannoma.  AJNR Am J Neuroradiol. 2000;  21 1540-1546
    Google Scholar
  • 20 Noren G, Greitz D, Hirsch A. et al . Gamma knife surgery in acoustic tumors.  Acta Neurochir. ((Suppl)) 1993;  58 104-107
    Google Scholar
  • 21 Okunaga T, Matsuo T, Hayashi Y. et al . Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images.  J Neurosurg. 2005;  103 53-58
    Google Scholar
  • 22 Pollock BE. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience.  Neurosurgery. 2006;  58 241-248
    Google Scholar
  • 23 Prasad D, Steiner M, Steiner L. Gamma surgery for vestibular schwannoma.  J Neurosurg. 2000;  92 745-759
    Google Scholar
  • 24 Prell J, Rampp S, Romstöck J. et al . Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma.  J Neurosurg. 2007;  106 826-832
    Google Scholar
  • 25 Romstöck J, Strauss C, Fahlbusch R. Continuous electromyographic monitoring of motor cranial nerves during cerebellopontine angle surgery.  J Neurosurg. 2000;  93 586-593
    Google Scholar
  • 26 Scheller C, Richter HP, Engelhardt M. et al . The influence of prophylactic vasoactive treatment on cochlear and facial nerve functions after vestibular schwannoma surgery: a prospective and open-label randomized pilot study.  Neurosurgery. 2007;  61 92-98
    Google Scholar
  • 27 Scheller C, Strauss C, Fahlbusch R. et al . Delayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment.  Zentrbl Neurochir. 2004;  64 103-107
    Google Scholar
  • 28 Selch MT, Pedroso A, Lee SP. et al . Stereotactic radiotherapy for the treatment of acoustic neuromas.  J Neurosurg. 2004;  101 362-372
    Google Scholar
  • 29 Strauss C, Romstöck J, Fahlbusch R. et al . Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery.  Neurosurgery. 2006;  59 577-584
    Google Scholar
  • 30 Szeifert GT, Figarella-Branger D, Roche PH. et al . Histopathological observations on vestibular schwannomas after gamma knife radiosurgery: the Marseille experience.  Neurochirurgie. 2004;  50 327-337
    Google Scholar

Correspondence

Dr. C. SchellerMD 

Department of Neurosurgery

University of Halle-Wittenberg

Ernst-Grube-Straße 40

06097 Halle (Saale)

Germany

Phone: 0345/557 13 99

Fax: 0345/557 14 12

Email: christian.scheller@medizin.uni-halle.de