Schwannoma of the Cranial Nerves—When To Operate?

Abstract

Despite the evolution of cranial base approaches and the improvement of intraoperative neurophysiological techniques, the management of intracranial schwannomas (both for the more common vestibular schwannomas and for less frequently treated schwannomas of other cranial nerves) remains challenging and the results of surgery remain better for smaller tumors. The time of treatment should be individualized by a well-experienced team. In fact, advances of skull base techniques and early diagnosis by means of MRI allowed the change of the goal of schwannoma surgery from life preservation to function preservation-recovery. The ideal treatment of intracranial schwannomas is total tumor excision with preservation of neurological function. Usually three groups of patients are considered at major surgical risk and the time and type of treatment is under discussion: elderly patients (more than 65 years), patients with medical problems, and patients with a previous partial tumor resection. In our experience the patient's general medical condition and life expectancy, more than his or her chronological age, are the factors to be considered when surgery is contemplated. In our opinion age is not a limit for patients in which schwannoma resection can be safely performed. Our policy is to offer conservative treatment with close radiological follow-up for elderly patients without severe neurological symptoms and without evidence of tumor growth on serial MRI scans. We adapt for radiosurgery patients in whom general medical problems or extremely advanced age contraindicate operative treatment.