cyberknife surgery symptoms

My husband had a schwanoma in2003. Most of it was removed with surgery. after 7 years of follow-up it returned. Docs recommended cyberknife surgery which was done December 09. since then symptoms have been worse than ever. headaches, facial seizures, eye twitching and seizures in both hand and feet. He has been weaned down to 4 mg. Dexamethasone and it doesn't eliminate symptoms. Has been off Keppra for a month with no changes. Are all these symptoms from swelling? And why is is bilateral? They told us the symptoms should only be on one side but they're not. Has also developed cataract in both eyes from the Steroids? or radiation? Any ideas would be welcome.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

First of all, I highly recommend you disccussing these concerns with your neurosurgeon and radiation oncologist. I will, however, try and give some information.

Radiosurgery is frequently used for schwannomas, AVM (i.e., a vascular malformation), and intracranial metastases. The major late complication of radiosurgery is radiation necrosis, which usually manifests as early as 2 to 4 months after treatment but maximal at 18 months. This complication is classified as neurotoxicity grades. Cognitive decline, personality changes, and even, seizures are a few of the complications of radiation.

I am not sure where the schwannoma is located that your husband had treated and thus it is impossible to comment on anatomical causes for your husbands symptoms from the cyberknife treatment.

Regarding the seizures: your husband needs to be seen by his neurosurgeon and perhaps a neurologist. Seizures can be of several types. There is a condition associated with focal brain lesions called epilepsia partialis continua. This condition is a form of “focal motor status epilepticus” and is difficult to treat. A thorough examination including an EEG should be performed. Keppra is a drug that is sometimes used to treat this condition. Another drug used is klonopin. These should be discussed with your neurosurgeon and/or neurologist.

Steroids do have side effects, such as weakening of bones, fluctuations in blood sugars, gastrointestinal tract upset, and cataracts. However, cataracts are also a condition that is seen as we age. If your husband has not been evaluated by an opthalmologist, he should. Dexamethasone is a medication used frequently in tumor patients to treat edema. You should have your husband discuss this medication and dosing with his neurosurgeon.

I recommend that you continue following up with your husband’s neurosurgeon and radiation oncologist. He may need to be seen by a neurologist for the seizure disorder. He would also be well-served to be seen by an ophthalmologist for the cataracts.

Thank you for using the forum, I hope you find this information useful, good luck.