Trigeminal schwannoma: a single-center experience with 43 cases and review of literature

Li, Mingchu; Wang, Xu; Chen, Ge; Liang, Jiantao; Guo, Haiqing; Song, Gang; Bao, Yijun

doi:10.1080/02688697.2020.1754334

Cited by 16 publications

(30 citation statements)

References 28 publications

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“…We believe that gross total resection of trigeminal schwannomas still remains superior to primary radiotherapy due to abovementioned facts and as complete resection of benign schwannomas can be equated to cure (except in NF2). We advocate microsurgical complete resection, as several studies showed satisfying results in > 70% of the patients by means of skull-base approaches and microsurgical dissection [2,23]. We could show, that, in contrast to more complicated reported techniques, feasible and more basic skull base approaches may be sufficient enough to attack trigeminal schwannomas.…”

Section: Discussionmentioning

confidence: 96%

“…Management of trigeminal schwannomas involves clinical and MRI-based follow-ups, surgical removal and, alternatively, radiotherapy or radiosurgery [2,6,12,[23][24][25]. Microsurgical techniques have decreased the morbidity of trigeminal schwannoma surgery, but the risk of complications, such as cranial nerve palsy and cerebrospinal fluid leak, still challenges GTR.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcome of Trigeminal Schwannomas

Aftahy

Groll

Barz

et al. 2021

Cancers

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(1) Background: As resection of trigeminal schwannomas is challenging, due to anatomical involvement of the anterior, middle and posterior fossa, the appropriate approach is important. We report our experience with surgical resection of trigeminal schwannomas by simple and classic skull-base approaches. (2) Methods: We performed a retrospective single-center study including patients who underwent surgery for trigeminal schwannoma tumors between June 2007 and May 2020, concentrating on surgical technique, extent of resection, postoperative outcome and complications. (3) Results: We included 13 patients (median age 57.5 with range of 36-83 years, 53.8% (7/13) female. The most common preoperative clinical presentations were facial pain in six (46.2%), hypoacusis in four (30.8%), trigeminal nerve hypesthesia in 11 (V1 46.2% (6/13), V2 (61.5% (8/13), V3 46.2% (6/13)) and headache in three (23.1%) patients. In three cases, the tumor was resected in a two-stage technique. The intradural subtemporal approach was performed in six cases, the extradural technique in two cases, the retrosigmoid approach in five cases, a Kawase approach in two cases and the transnasal endoscopic approach in one case. The gross total resection rate was 76.9% (10/13) and the median follow-up time 24.0 (0–136) months. Three (23.1%) patients developed postoperative anesthesia in at least one branch of the trigeminal nerve. Trigeminal motor function was preserved in 11 (84.6%) patients. Ten of the 11 patients (76.9%) who reported decreased gustation, cerebellar ataxia, visual impairment, or headache improved postoperatively. Two (15.4%) patients exhibited minimal facial palsy (House and Brackmann II–III), which resolved during the follow-up. The total adverse event rate requiring surgical intervention during follow-up was 7.7%. Surgery-related mortality was 0%. (4) Conclusions: Trigeminal schwannomas are rare benign lesions with intra- and extracranial extension. Considering the low operative morbidity and satisfying functional outcome, gross total resection of trigeminal schwannomas is achievable by classic, but also individually tailored approaches. More invasive or combined techniques were not needed with meticulous surgical planning.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Surgical Outcome of Trigeminal Schwannomas

Aftahy

Groll

Barz

et al. 2021

Cancers

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“…Currently, the RSA remains the gold standard for pathologies in the CPA; the conventional technical notes have been described previously in detail ( 1 – 4 , 8 – 10 , 14 , 17 , 34 , 35 ). The RSA is the most commonly used approach in removing vestibular schwannomas or CPA meningiomas.…”

Section: Discussionmentioning

confidence: 99%

The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases

et al. 2022

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IntroductionExposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications, and approach-related outcomes.Materials and MethodsWe performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery for oncologic lesions through RSAs, concentrating on surgical technique, postoperative outcome, and complications.ResultsA total of 449 RSAs were included. The median age at the time of surgery was 58 years; 168 (37.4%) were male and 281 (62.6%) were female. The median approach surface was 7.8 cm2. The median tumor volume was 5.9 cm3. The median Clavien–Dindo grade was 2, the total complication rate was 28.7%, and gross total resection (GTR) was 78.8%. Findings revealed that tumor volume had no significant impact on postoperative complications in general (p = 0.086) but had a significant impact on postoperative hemorrhage (p = 0.037) and hydrocephalus (p = 0.019). Tumor volume was significant for several preoperative symptoms (p < 0.001). The extent of the approach had no significant impact on complications in general (p = 0.120) but was significant regarding postoperative cerebrospinal fluid (CSF) leaks (p = 0.008). Craniotomy size was not significant regarding GTR (p = 0.178); GTR rate just missed significant correlation with tumor volume (p = 0.056). However, in the case of vestibular schwannomas, the size of craniotomy was important for GTR (p = 0.041).ConclusionTumor volume has an important impact on preoperative symptoms as well as on postoperative complications. Although the extent of the craniotomy barely missed significance regarding GTR, a correlation can be assumed. Thus, the extent of craniotomy should be taken into presurgical consideration, especially in the case of postoperative CSF leaks. Regarding vestibular schwannomas, craniotomy size plays an important role in achieving satisfactory oncological outcomes. Different approaches should be selected where necessary regarding superior resection rates.

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“…Trigeminal schwannoma (TS) is a rare entity, representing less than 0.5% of intracranial neoplasms and approximately 0.8% to 8% of intracranial schwannomas overall. 1,2 Peak incidence occurs in the third and fourth decades of life; pediatric cases are exceedingly rare, with only a handful having been reported in the literature. [3][4][5][6][7] Patients may present with trigeminal nerve dysfunction, headaches, dysphagia, or diplopia (although many cases are discovered incidentally).…”

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confidence: 99%

“…10 Resection remains the gold standard treatment, but the choice of approach is nuanced and depends largely on tumor anatomy and surgeon comfort. For both adult and pediatric multicompartmental lesions, surgical corridors may include combinations of presigmoid, frontotemporal, subtemporal/ transpetrosal, and two-stage middle and posterior fossa exposures, [2][3][4][5][6]11 with or without the addition of endonasal endoscopic 2,[12][13][14][15][16] or transfacial (transmaxillary/transmandibular) approaches to target significant infratemporal extension. 4,11,[17][18][19] Management of TS in pediatric patients presents additional challenges because of anatomical differences, the potential for impact on development, and the need to minimize blood loss.…”

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confidence: 99%

Pediatric multicompartmental trigeminal schwannoma: illustrative case

Landry

Vaughan

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

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Trigeminal schwannoma: a single-center experience with 43 cases and review of literature

Cited by 16 publications

References 28 publications

Surgical Outcome of Trigeminal Schwannomas

Surgical Outcome of Trigeminal Schwannomas

The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases

Pediatric multicompartmental trigeminal schwannoma: illustrative case

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