Gamma Knife Surgery for Hemifacial Spasm Related to Cerebellopontine Angle Tumors

Keywords: hemifacial spasm, gamma knife, vestibular schwannoma, meningioma, outcome

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     Most of tumor-related hemifacial spasm (HFS) reported was treated by open surgery. 
     We report the effect of GKS on benign tumor-related HFS at a follow-up of 84 months.
     From 2000 to 2011, a total of 6 patients with cerebellopontine tumors (4 meningiomas, and 2 schwannomas) with HFS underwent GKS as a primary treatment.
     These patients had tumors within the radiosurgical target area. For meningiomas, the mean radiosurgical treatment volume was 5.3 ml (range 1.2-9.2 ml), and the mean radiosurgical tumor margin dose was 14.1Gy (range 12-18 Gy); for 2 schwannomas, the volume was 2.5 ml and 11.2 ml, and the marginal dose was 12 Gy. Five patients were female and one male. The mean duration of HFS was 15.5 months (range 3-36 months). The mean age at the time of radiosurgery was 52.7 years (range, 45-60 years).
     The mean follow-up period was 84 months (range 40 to 110 months). Overall, 4 of 6 patients (66 %) experienced complete HFS relief without medication after GKS and one patient had a good outcome. The mean time of the improvement was 7 months (range 2 to 18 months). Only one patient had failed relief of HFS and coincidentally this tumor size was not shrunk. For all 6 patients (100%), there was tumor growth control at a mean follow-up of 56 months after GKS, four of them had tumor size decreased and two were not changed. Two patients with facial numbness reported improvement after tumor shrinkage.
     This was a retrospective series.
     GKS appears to be an effective tool to treat benign tumor related HFS and control tumor growth. 
     Reduction of tumor volume is related to spasm improvement.


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