Abstract
Simple SummaryTrigeminal schwannomas are the most common among non-vestibular schwannomas. Treatment of trigeminal schwannomas may be challenging due to critical anatomical relations and involvement of different aspects of the skull base. Advances in microsurgery have led to improved outcomes over the last decades, whereas in contrast, some advocate stereotactic radiotherapy as an effective therapy, controlling the tumor volume with few complications. In this manuscript, we present outcome and adverse events in a contemporary cohort of trigeminal schwannomas and discuss surgical advantages and disadvantages of different performed classic skull-base approaches. (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.
Highlights
We present outcome and adverse events in a contemporary cohort of trigeminal schwannomas and discuss surgical advantages and disadvantages of different performed classic skull-base approaches
Data in text and graphs are shown as median with underwent surgery for trigeminal schwannomas between June 2007 and May 2020 at the interquartile range (IQR) or mean ± standard deviation (SD)
In case of STR, postoperative radiation may be discussed for better local control
Summary
IntroductionTrigeminal schwannomas among non-vestibular schwannomasTrigeminal schwannomasare arethe themost mostcommon common among non-vestibular schwannoand account for of intracranial schwannomas and of intracranial mas and account for 1.0 to 8.0% of intracranial schwannomas and 0.1 to 0.5% of intracratumors [1,2].Treatment of trigeminal schwannomas may be be challenging due to to critical nial tumorsTreatment of trigeminal schwannomas may challenging due critianatomical relations andand involvement of different aspects of the skull base.When planning cal anatomical relations involvement of different aspects of the skull base.When planan optimal surgical treatment strategy, one must take various factors into account.ning an optimal surgical treatment strategy, one must take various factors into account.They can can arise arise anywhere anywhere between between the the root root and and the the distal distal extracranial extracranial branches of theThey trigeminal nerve nerve originating originating from from the the root, root, the the ganglion, ganglion, or the the peripheral peripheral branches of the trigeminal trigeminal nerve [2] Trigeminal schwannomasare arethe themost mostcommon common among non-vestibular schwannoand account for of intracranial schwannomas and of intracranial mas and account for 1.0 to 8.0% of intracranial schwannomas and 0.1 to 0.5% of intracratumors [1,2]. Treatment of trigeminal schwannomas may challenging due critianatomical relations andand involvement of different aspects of the skull base. When planan optimal surgical treatment strategy, one must take various factors into account. Ning an optimal surgical treatment strategy, one must take various factors into account. They can can arise arise anywhere anywhere between between the the root root and and the the distal distal extracranial extracranial branches of the.
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