Case description

This is a 59-year-old patient with an incidental lesion compatible with a right cisternal trigeminal schwannoma (TS) on brain magnetic resonance imaging (MRI) ( Figure 7.34.1 ). Initial “wait-and-scan” strategy was pursued. During serial follow-up MRIs, the TS exhibited volumetric growth of approximately 30%, without any new symptoms. Gamma Knife radiosurgery (GKR) treatment was then performed ( Figure 7.34.2 ).

From left to right: T1-gadolinium injected MRI in coronal, axial, and sagittal planes showing a lesion centered at the cisternal part of the trigeminal nerve, without contact with the brainstem.

From left to right: T1 noninjected MRI, T1-gadolinium injected MRI, bone CT in the axial plane. The dosimetry is colored in yellow and corresponds to the 12-Gy dose prescription. We always use multimodal imaging for target definition, which may also include T2 CISS/Fiesta sequences.

Critical Structure	Dose Tolerance
Brainstem	Marginal dose of 12 Gy due to absence of direct contact between TS and brainstem; the risk of adverse radiation events (ARE) at the brainstem level is virtually zero

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