Surgical treatment of trigeminal schwannomas

Abstract

A total of 27 patients with trigeminal schwannoma were treated between 1982 and 1992 at the Neurosurgery Department of Nordstadt Hospital. Twelve cases of solitary schwannoma without any family history or physical stigmata of neurofibromatosis were included and form the basis of this study. There were four women and eight men (mean age 44 years) in this series. Duration of symptoms ranged from 2 months to 6 years. The most frequent symptoms were either pain or numbness of the ipsilateral hemiface. The surgical approach was chosen depending on the tumor type. Tumors that belonged to Type A (five cases), which were predominantly in the middle fossa, were approached using a transsylvian method; Type B (one case), which presented predominantly in the cerebellopontine angle, was operated on via a retrosigmoid suboccipital craniectomy; Type C (five cases), which were dumbbell-shaped extending into both the middle and posterior fossa, were removed via a combined temporal craniotomy-presigmoidal method; and in Type D (one case), in which tumor was primarily extracranial with intracranial extension, an infratemporal extradural approach was undertaken. There was no operative mortality or long-term disability in this series. The follow-up period ranged from 12 to 60 months; during that time magnetic resonance imaging revealed tumor recurrence in two cases after 12 and 48 months, respectively, and these were excised again. An additional 178 cases collected from the world literature are also reviewed and analyzed.

Dural relationships of Meckel cave and lateral wall of the cavernous sinus

“…28 Modifications of this classification have been proposed by other authors. 12,39,49,55,62 Almost half of schwannomas are located within the MC.…”

Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

“…The lower cranial nerves must be carefully evaluated, because these are the source of major and life-threatening postoperative complications, especially if the patient had no deficits preoperatively. The acute development of postoperative deficits in such patients allows no chance for compensatory mechanisms to develop 25 . Speech pathology and otolaryngological evaluations with pre and postoperative swallowing, as well as audiological studies, are essential in the treatment of these patients.…”

“…Although in early surgical series 23 a mortality rate as high as 16% had been reported, recent advances in surgical microneuroanatomy, neuroradiology, and microsurgical and skull base techniques have drastically decreased this rate, and no deaths directly related to the surgical 187 procedure have been reported in the latest series 9,[11][12][13][14][15][16][17][20][21][22][23][24][25] . The lower cranial nerves must be carefully evaluated, because these are the source of major and life-threatening postoperative complications, especially if the patient had no deficits preoperatively.…”

“…The tumor's location and extension defines the surgical approach. For tumors confined intracranially (Type A), a retrosigmoid approach provides adequate exposure 25 . For tumors involving the bone window, a wider exposure is required.…”

Voluminous Cystic Trigeminal Schwannoma: Case Report and Literature Review

“…Trigeminal neurinomas can however, if small, arise from any portion of the trigeminal nerve namely cisternal, gasserian or the postganglionic section made of any of the three peripheral divisions of the nerve (ophthalmic, maxillary and mandibular). These tumors account for 0.07% to 0.36% of all intracranial tumors, around a third of all tumors of Meckel's cave and 0.8% to 8% of all intracranial schwannomas [6] [10] [13] [14] [15] [17] [18] [19]. As with other schwannomas, there could be an association with Neurofibromatosis type 2.…”