title: Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.
abstract: We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema.
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kapitza
authors.affiliation: Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Athina
authors.initials: A
authors.lastname: Pangalu
authors.affiliation: Gamma Knife Center Krefeld, Krefeld, Germany.
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Horstmann
authors.affiliation: Gamma Knife Center Krefeld, Krefeld, Germany.
authors.forename: Albert T
authors.initials: AT
authors.lastname: van Eck
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.affiliation: Department of Neurosurgery, University Hospital Zurich and University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland. Electronic address: alexander.tarnutzer@usz.ch.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Tarnutzer
mesh_terms: D000208:Acute Disease; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects*
keywords: Gamma Knife radiosurgery; MRI; Necrosis; Vestibular schwannoma