Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy.

OBJECT: The purpose of this retrospective study was to compare the effectiveness of gamma knife radiosurgery (GKS) for multiple cerebral metastases with that of whole-brain radiation therapy (WBRT). METHODS: Ninety-six consecutive patients with cerebral metastases from nonsmall cell lung cancer were treated between 1990 and 1999. The entry criteria were the presence of between one and 10 multiple brain lesions at initial diagnosis, no surgically inaccessible tumors with more than a 30-mm diameter, no carcinomatous meningitis, and more than 2 months of life expectancy. The patients were divided into two groups: the GKS group (62 patients) and the WBRT group (34 patients). In the GKS group, large lesions (> 30 mm) were removed surgically and all other small lesions (< or = 30 mm) were treated by GKS. New distant lesions were treated by repeated GKS without prophylactic WBRT. In the WBRT group, the patients were treated by the traditional combined therapy of WBRT and surgery. In both groups, chemotherapy was administered according to the primary physician's protocol. The two groups did not differ in terms of age, sex, initial Karnofsky Performance Scale (KPS) score, type, lesion number, and size of lesion, systemic control, and chemotherapy. Neurological survival and qualitative survival of the GKS group were longer than those of the WBRT group. In multivariate analysis, significant poor prognostic factors were systemically uncontrolled patients, WBRT group, and poor initial KPS score. CONCLUSIONS: Gamma knife radiosurgery without prophylactic WBRT could be a primary choice of treatment for patients with as many as 10 cerebral metastases from nonsmall cell cancer.

Schwannoma of the spinal accessory nerve.

The authors report a case of a schwannoma originating from the spinal root of the accessory nerve. The patient was a 40-year-old woman with chronic headache and blurred vision. A neurological examination failed to reveal any abnormal findings except for papilloedema. A computed tomographic (CT) scan showed hydrocephalus and a magnetic resonance image (MRI) on admission showed an enhancing extramedullary tumour located at the level of foramen magnum. The tumour was successfully removed and was verified to originate from the spinal root of the right accessory nerve. The hydrocephalus improved soon after surgery. The patient left hospital in a satisfactory condition. There are 15 cases of accessory nerve schwannomas reported in the literature; the authors report the 16th. Although accessory nerve schwannoma is very rare, one should consider it as one of the differential diagnoses for tumours at the foramen magnum.