Object The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension. Methods A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year. Results Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively. Conclusions The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.

.ABSTRACT -Partial and generalized tonic-clonic reflex seizures related to hot water bathing have been described as temperature-related. We describe three cases of bathing epilepsy: a 28 year-old white male and a 30 year-old white female with spells triggered either by warm or hot water, and a 32 year-old female with spells triggered by hot water. The later two of the three cases presented localized epilepsy and a familial history of epilepsy. A complex tactile stimuli might play the most relevant role on seizure triggering, as well as water temperature with an additive effect over cutaneous stimulation.KEY WORDS: epilepsy, epilepsy-generalized, epilepsy-localized, seizures-reflex, hot-water epilepsy.Epilepsia do banho quente, do banho morno, ou apenas do banho? Relato de três casos e considerações sobre um velho tema RESUMO -Crises reflexas a banhos quentes, tônicas-clônicas parciais e generalizadas foram descritas como relacionadas à temperatura. Descrevemos três casos de epilepsia do banho quente: um homem de 28 anos e uma mulher de 30 anos com crises provocadas por contato com água morna ou quente e uma mulher de 32 anos com crises ao contato com água quente. Os últimos dois casos apresentaram epilepsia localizada e um histórico familiar de epilepsia. Nesta forma de epilepsia, um estímulo táctil complexo parece ter o p a p e l mais relevante na precipitação das crises, sendo potencializado pela temperatura da água. PALAVRAS-CHAVE: epilepsia, epilepsia generalizada, epilepsia localizada, crises reflexas, epilepsia do banho quente.Hot water epilepsy has been previously studied and re p o rted, occurring mainly in India 1 , 2 , 3 . Both partial and generalized tonic-clonic seizures related to hot water bathing have been described as tempera t u re -related, often triggered by temperatures ranging from 40 to 50 o C 1 -3 . As in many other types of re f l e x s e i z u res, the same stimulus (hot water) triggers either generalized tonic-clonic or partial seizures, suggesting that generalized and localized epilepsies might be influenced by the same aff e rent pathways.We describe three cases of bathing epilepsy, one t r i g g e red by hot water, and the other two either by w a rm or hot water. The pathophysiological significance of seizure triggering by warm water and the proper denomination of this syndrome is discussed. CASESCase 1 -A 28 year-old white male started having seiz u res at the age of 7. Seizures would start with dizziness, followed by left hemiclonic seizures starting on his left arm . He had had birth anoxia, and his brother also had epileps y. Seizures were initially controlled with phenobarbital, but re c u rred at the age of 14, when partial seizures characterized by bilateral headache, cephalic paresthesia, and a negative motor phenomenon on his left upper limb w e re triggered either by warm (but not cold) or hot water. Symptoms lasted about 5 minutes. The CT was normal, but an interictal EEG showed a right rolandic focus and an independent left temporal spiking. Carbamazepine 1200mg/day...