Trigeminal Schwannoma Research Articles

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

Objective Trigeminal schwannomas (TS) are rare, when compared to vestibular schwannomas. The present study aims to analyze the clinical characteristics and surgical strategies of TS via the retrospective analysis of the clinical data of 43 patients. Methods The clinical information of 43 patients diagnosed with TS, who were surgically treated from January 2008 to January 2018, was retrospectively analyzed. Then, the selection of approaches and surgical strategies were discussed. Results During the last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University. Facial numbness and hypoesthesia were the most common symptoms, which developed in 29 cases (67.4%). Typical trigeminal neuralgia was complained by four patients (9.3%), while trigeminal motor impairment developed in nine cases (20.9%). The tumor was totally removed in 39 patients (90.7%), near-totally removed in three patients (7.0%), and partially removed in one patient (2.3%) due to intraoperative internal carotid artery (ICA) injury. The abducens was intraoperatively damaged in two patients (4.7%). After the operation, all four patients with trigeminal neuralgia achieved total recovery, but the facial numbness still continued in 24 patients (82.8%). At a median of 45.3 ± 25.5 (6–84) months of follow up, a tumor recurred in only one patient, and this patient received a second operation. Conclusion It can be concluded that total removal via the proper approach can be the best treatment for TS with a low complication rate. However, preoperative symptoms, such as facial numbness and trigeminal motor impairment that seldom improved though normal fibers, were carefully recognized and preserved during the operation.

Successful endoscopic endonasal surgery for very huge trigeminal schwannomas in nasopharynx

We present a 60-year-old female diagnosed with a giant trigeminal tumor (5.2*6.4*8.2 cm) situated in the middle cranial fossa and nasopharyngeal area. The patient was operated on by endoscopic endonasal transmaxillary, transpterygoid and infratemporal approaches. Postoperatively she was stable, with no neurologic complication and no cerebrospinal fluid leakage. We review the literature on extremely large trigeminal schwannomas.

Intracranial emergencies during pregnancy requiring urgent neurosurgical treatment

ObjectiveDespite contemporary diagnostic and therapeutic techniques intracranial emergencies in the obstetric setting pose still a major challenge for the clinicians. There are limited guidelines and differing ethical views. Multidisciplinary teams are needed to support the pregnant woman in a way that she can deliver a viable and healthy child. The aim of the present study was to scrutinize the management of intracranial emergencies during pregnancy which needed urgent neurosurgical treatment. Patients and methodsData of all pregnant women who presented with newly diagnosed intracranial pathologies and neurological symptoms caused by these pathologies in an emergency setting were collected over a 10-year period (2008–2018). Patient characteristics including maternal age, gestational age, and preoperative work-up of both mother and fetus were recorded. Furthermore, the surgical treatment, mode of delivery, and neonatal and maternal outcomes were analysed. ResultsThe mean maternal age was 32.7 years and most patients were in their third trimester. There was one twin pregnancy (total of 12 fetuses). Five out of eleven pregnant women suffered from intracerebral haemorrhage (epidural haematoma (1), arteriovenous malformation (1), subarachnoid haemorrhage (2) and intracerebral haemorrhage (1)) and the other six patients had intracranial neoplasms (primary meningeal sarcoma (1), trigeminal schwannoma (1), anaplastic astrocytoma (2), glioblastoma (1) and sphenoid wing meningioma (1)).Neurosurgical procedures were performed via craniotomies in eight patients. A stereotactic biopsy via a frontal burr hole was achieved one patient. The two other patients with subarachnoid haemorrhage due to rupture of PICA aneurysms were treated with coil embolization. Depending on the gestational age and the clinical condition of the pregnant women it was decided to perform an emergency Caesarean section prior to further therapeutic measures in seven patients. Two out of 12 fetuses were unviable. Six women survived, while five women succumbed to the intracranial pathology. ConclusionThe individualized treatment approach in this peculiar obstetric scenario needs to consider various issues such as the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. The primary concern in this context must be the mother`s health and safety. Caesarean section is the primary mode of delivery in most cases. While contemporary care can insure survival for the majority of infants, maternal mortality still poses an extraordinary challenge. Interdisciplinary consulting of the patient and/or her family is necessary to develop a treatment strategy for both the expectant woman and her offspring.

Expanded endoscopic endonasal transpterygoid transmaxillary approach for a giant trigeminal schwannoma.

Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery.The video can be found here: https://youtu.be/6pSwdYsN9hk.

Malignant trigeminal nerve Schwannoma diagnosed via biopsy of the infraorbital nerve in a dog

A 12-year old, female neutered English Pointer presented with right-sided temporalis muscle atrophy and facial irritation over 2 weeks. Neurolocalisation was consistent with a right trigeminal neuropathy. MRI revealed a...

In Reply to the Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review and Operative Video”

In Reply to the Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review and Operative Video”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video”

A Giant Trigeminal Schwannoma, Posterior Fossa and Middle Fossa Extradural Approach: A Case Report

Trigeminal schwannomas are rare tumors that are located in the posterior and middlecranial fossae in about a quarter of the cases. The presentation pattern is differentaccording to the involved compartment and the goal of surgery is complete removal.We present the case of a 28-years old man who presented with a left sided trigeminalschwannomas extending from the posterior to the middle fossa. Middle fossa part ofthe tumour was removed by extradural subtemporal approach and posterior fossapart was removed by retrosigmoidretromastoid approach Bang. J Neurosurgery 2020; 9(2): 162-167

Prominent auditory and balance disturbances in a patient with trigeminal nerve schwannoma

Trigeminal nerve schwannoma, a rare type of schwannoma, can be challenging to be diagnosed. Its initial clinical presentations may be subtle in nature but could deteriorate rapidly once the mass is large enough to compress the surrounding nerves. In this article, we report a case of a 55-year-old Malay female who complained of only numbness (without other symptoms) during her visit in the year 2014. As such, the otological findings were unremarkable. In the year 2017, her condition was worsening to the extent that she was not able to walk or stand independently and her hearing had dropped to a profound level in the right side. Low gain on the anterior and lateral right semicircular canals was found in video head impulse test, suggesting the hypofunction of the right semicircular system. The magnetic resonance imaging was carried out, and the presence of mass at the trigeminal nerve was confirmed. It is important to highlight that the auditory and balance can be prominently affected in trigeminal nerve schwannoma. Audiological and vestibular assessments are important to complement the diagnosis and prognosis of the patient.

Trigeminal Schwannoma simulating orofacial pain: differential diagnosis and treatment. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Orofacial pain is a major diagnostic challenge for the most experienced clinicians. Due to the complexity regarding the trigeminal-cervical joint, orofacial pain with the same etiology may present different symptoms, and pain with similar symptomatology may have different causes. The objective of this study was to alert health professionals about the importance of differential diagnosis in the hypothesis of trigeminal neuralgia, where the inclusion of the dentist in the medical-hospital team is of paramount importance in establishing the correct diagnosis. CASE REPORT: Twenty-nine-year-old female patient complained of electric shock and pulsatile orofacial pain that covered the third division of the fifth cranial nerve on the right side. Magnetic resonance imaging revealed the presence of trigeminal Schwannoma, causing neuralgia due to its neural compressive nature. Two different neurosurgery departments suggested tumor resection. However, after the evaluation by a third neurosurgery department, in which a dentist, specialized in orofacial pain was part of the team, the complete evaluation established the final diagnosis of right lower first molar odontalgia, with irreversible acute pulpitis as the cause of the symptoms and the expansive lesion was only a radiological finding. CONCLUSION: Interdisciplinary evaluation among physicians and dental surgeons is necessary to obtain the correct diagnosis when considering the hypothesis of trigeminal neuralgia.

Endoscope-Assisted Retromastoid Intradural Suprameatal Approach for Trigeminal Schwannoma.

Dumbbell trigeminal schwannoma is the second most common type of intracranial schwannomas. Herein, we are describing and presenting a video of left trigeminal dumbbell schwannoma with a predominant posterior fossa component (modified Samii's grade C1), operated through left Retromastoid Intradural Suprameatal Approach (RISA). We demonstrate a step by step technique of a previously defined procedure for educational purpose. The patient was placed in the right lateral position, and left retromastoid craniotomy was done. Dura was opened based on transverse and sigmoid sinus to expose tumors in the suprameatal region. The tumor removed piecemeal under the microscope, and later endoscope was introduced to identify and remove the residual tumor in the superolateral part of Meckel's cave. The patient had an uneventful recovery. Trigeminal schwannoma with a predominantly posterior fossa component can be excised through retromastoid sub-occipital craniotomy. Endoscopic-assisted microsurgery should be considered in all skull base tumors. Aim for complete excision, but safe maximal resection with GKRS for residual can be considered in difficult cases.

Surgical excision of trigeminal (V3) schwannoma through endoscopic transpterygoid approach

Background:Endoscopic endonasal transpterygoid (EET) approach is well suited for trigeminal schwannomas.Case Description:A 25-year-old female presented with the right hemifacial pain for 1 month. Examination revealed mild sensory loss to both touch and pain in the right V2 and V3 dermatomal distribution. On magnetic resonance imaging, a well-defined extra-axial lesion was seen in the right infratemporal fossa extending intracranially, widening the foramen ovale. Erosion of the lateral pterygoid plate was evident on computed tomography. Diagnosis of a trigeminal schwannoma was made and excision through endoscopic transnasal transpterygoid approach was planned. After adequate nasal decongestion, lateralization of the inferior turbinate followed by medialization of middle turbinate done to expose the posterior part of the lateral nasal wall. Sphenopalatine foramen was visualized and the branches of the sphenopalatine artery to turbinate were coagulated followed by partial inferior and middle turbinectomy. Next, antegrade uncinectomy, bullectomy, and middle meatal antrostomy performed. Anterior and posterior ethmoidectomy was done to gain access to the sphenoid sinus. Medial maxillectomy done, posterior maxillary sinus wall exposed and drilled to reach infratemporal fossa harboring the tumor. The lateral recess was further exposed to visualize the vidian and maxillary nerves. Palatine bone and pterygoid body along with the medial pterygoid plate were completely drilled to expose the tumor capsule, which was gently dissected off. Complete tumor excision was performed uneventfully.Conclusion:EET provides a good oncological and functional outcome. With a lesser risk of surgical morbidities, it is an excellent alternative to conventional skull base approaches to trigeminal schwannomas in the modern era.

Anterior Transpetrosal Approach for Trigeminal Schwannoma with Persistent Primitive Trigeminal Artery: 2-Dimensional Operative Video.

The surgical management of trigeminal schwannomas often requires complicated skull base approaches based on detailed anatomical understanding because of the involvement of multiple compartments of the trigeminal nerve from its root to the peripheral branches. When there is vital anatomical anomaly around the tumor, this can make the surgical management and anatomical understanding more difficult.1,2 This video demonstrates the microsurgical removal of a dumbbell-shaped trigeminal schwannoma via the anterior transpetrosal transtentorial approach in a patient with a persistent primitive trigeminal artery, the most common persistent embryonic carotid-vertebrobasilar anastomosis. A 32-yr-old woman presented with progressive facial sensory impairment, dizziness, and slight diplopia because of right abducens palsy. Neuroimaging revealed a right Meckel's cave tumor extending to both the middle and posterior cranial fossae and displacing the abducens nerve inferomedially. The persistent primitive trigeminal artery, which is an anomalous communication between the cavernous carotid and basilar arteries, was identified ventral to the tumor. While preserving most of the noninvaded trigeminal nerve, gross-total resection was achieved under direct visualization of the abducens nerve and persistent primitive trigeminal artery, piercing the dura of the posterior cavernous sinus and coursing medially along the clivus. The patient's facial sensory impairment and diplopia almost disappeared without new neurological deficits or tumor recurrence during the follow-up period of 1 yr. Three-dimensional reconstructed images demonstrated the anatomical relationship of the tumor, the persistent primitive trigeminal artery, and the extent of osseous drilling of the petrosectomy. Informed consent was obtained from the patient.

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video”

In Reply to the Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

In Reply to the Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

Skull Base Manifestations of Erdheim-Chester Disease: A Case Series and Systematic Review.

Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis. Up to 50% of patients develop central nervous system involvement, and a subset of these patients can present with isolated tumor-like masses. To describe the skull base manifestations of ECD with an emphasis on aspects most pertinent to surgeons who may be referred such patients for primary evaluation. Scopus, Web of Science, and PubMed were searched from database inception to May 1, 2018 for articles reporting skull base ECD. An institutional retrospective analysis of all patients treated at the authors' institution since January 1, 1996 was also performed to supplement these data. Of 465 retrieved articles, 18 studies totaling 20 patients met inclusion criteria. Institutional review identified an additional 7 patients. Collectively, the median age at diagnosis was 49 yr (interquartile range, 42-58) with a 4:1 male-to-female ratio. Patients frequently presented with diplopia (48%), headache (30%), dysarthria (22%), and vertigo or imbalance (22%), though trigeminal hypesthesia (11%), facial nerve paresis (7%), hearing loss (7%), and trigeminal neuralgia (7%) were also observed. ECD commonly mimicked meningioma (33%), trigeminal schwannoma (8%), neurosarcoidosis (8%), and skull base lymphoma (8%). Discrete skull base lesions frequently mimic more common pathology such as meningioma or cranial nerve schwannomas. Medical therapy comprises the initial treatment for symptomatic skull base disease. Surgical resection is not curative and the utility of surgical intervention is largely limited to biopsy to establish diagnosis and/or surgical debulking to relieve mass effect.

In Reply to “Pediatric Trigeminal Schwannoma: From a ‘Minimally Invasive’ to a Combined Endovascular and Surgical Management”

In Reply to “Pediatric Trigeminal Schwannoma: From a ‘Minimally Invasive’ to a Combined Endovascular and Surgical Management”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

Letter to the Editor Regarding “Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Video Submission”

Malignant Peripheral Nerve Sheath Tumor with Loss of SMARCB1 and Diffuse S1000 Expression Arising in a Trigeminal Nerve Schwannoma

Abstract Malignant peripheral nerve sheath tumors (MPNSTs) are rare sarcomas of the nerve sheath that infrequently involve the head and neck region. The few reports of MPNSTs arising from benign schwannoma precursors typically exhibit epithelioid morphology. We describe an exceptional case of a conventional MPNST arising in a benign trigeminal nerve schwannoma of a 21-year-old man without neurofibromatosis or familial schwannomatosis. Histologically, the tumor consisted of spindle-shaped cells in a fascicular and focal whorling growth pattern, with extensive geographic necrosis, cytologic atypia, rare atypical mitotic figures and focal histologic features of cellular schwannoma. Immunohistochemically, the tumor cells showed strong and diffuse S100 positivity and loss of SMARCB1. Subsequent genomic sequencing revealed a single nucleotide deletion (c.1148delC) in the SMARCB1/INI1 gene Diffuse S100 positivity and/or loss of SMARCB1 expression is extremely rare in conventional MPNST. We discuss diagnostic considerations for MPNSTs and review the literature concerning treatment of these rare neoplasms.