E-ISSN: 1019-5157 ISSN: 2651-5024
Gamma Knife Radiosurgery-Induced Acute Facial Palsy in Vestibular Schwannoma: A Case Report
1Acibadem Kent Hospital, Department of Radiation Oncology, İzmir, Türkiye
2Acibadem Kent Hospital, Department of Neurosurgery, İzmir, Türkiye
Page : 620-623

Stereotactic radiosurgery (SRS) is an established treatment for vestibular schwannoma, offering high tumor control rates and a favorable safety profile. SRS-induced facial palsy is typically a late-onset complication, with acute-onset cases being exceedingly rare. We report the case of a 42-year-old man with a left-sided Koos grade I vestibular schwannoma who underwent single-fraction Gamma Knife radiosurgery with a prescription dose of 11 Gy to the 50% isodose line. Baseline facial nerve function was intact. Seventy-two hours post-treatment, the patient developed House-Brackmann (HB) grade V peripheral facial palsy, accompanied by severe vestibular symptoms. Magnetic resonance imaging obtained on post-treatment day 6 demonstrated reduced contrast enhancement, partial capsular breakdown, and central hypointensity within the tumor, suggestive of acute necrotic change. Vestibular symptoms improved rapidly following corticosteroid therapy; however, facial palsy recovery was gradual, improving to HB grade II at 12 months, with persistence at final follow-up (20 months). The tumor remained radiologically stable. Acute-onset facial palsy following SRS for vestibular schwannoma is extremely rare, with only four previous cases reported in the literature. This is the first reported case to occur following a relatively low margin dose—11 Gy—in contrast to the 13-14 Gy doses prescribed in earlier reports.

Keywords : Schwannoma Gamma Knife radiosurgery facial palsy
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