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01-12-2024 | Schwannoma | Original Article

Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series

Authors: Matthew C. Findlay, Michael T. Bounajem, Vance Mortimer, Karol P. Budohoski, Robert C. Rennert, William T. Couldwell

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Background

Trigeminal schwannomas (TSs) are intracranial tumors that can cause significant brainstem compression. TS resection can be challenging because of the risk of new neurologic and cranial nerve deficits, especially with large (≥ 3 cm) or giant (≥ 4 cm) TSs. As prior surgical series include TSs of all sizes, we herein present our clinical experience treating large and giant TSs via microsurgical resection.

Methods

This was a retrospective, single-surgeon case series of adult patients with large or giant TSs treated with microsurgery in 2012–2023.

Results

Seven patients underwent microsurgical resection for TSs (1 large, 6 giant; 4 males; mean age 39 ± 14 years). Tumors were classified as type M (middle fossa in the interdural space; 1 case, 14%), type ME (middle fossa with extracranial extension; 3 cases, 43%), type MP (middle and posterior fossae; 2 cases, 29%), or type MPE (middle/posterior fossae and extracranial space; 1 case, 14%). Six patients were treated with a frontotemporal approach (combined with transmastoid craniotomy in the same sitting in one patient and a delayed transmaxillary approach in another), and one patient was treated using an orbitofrontotemporal approach. Gross total resection was achieved in 5 cases (2 near-total resections). Five patients had preoperative facial numbness, and 6 had immediate postoperative facial numbness, including two with worsened or new symptoms. Two patients (28%) demonstrated new non-trigeminal cranial nerve deficits over mean follow-up of 22 months. Overall, 80% of patients with preoperative facial numbness and 83% with facial numbness at any point experienced improvement or resolution during their postoperative course. All patients with preoperative or new postoperative non-trigeminal tumor-related cranial nerve deficits (4/4) experienced improvement or resolution on follow-up. One patient experienced tumor recurrence that has been managed conservatively.

Conclusions

Microsurgical resection of large or giant TSs can be performed with low morbidity and excellent long-term cranial nerve function.

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Abou-Al-Shaar H, Cohen MA, Bi WL et al (2020) Surgical management of multifocal trigeminal schwannomas. Oper Neurosurg (Hagerstown) 19(6):659–666CrossRefPubMed

Abou-Al-Shaar H, Krisht KM, Cohen MA et al (2020) Cranio-orbital and orbitocranial approaches to orbital and intracranial disease: eye-opening approaches for neurosurgeons. Front Surg 7:1CrossRefPubMedPubMedCentral

Aftahy AK, Groll M, Barz M et al (2021) Surgical outcome of trigeminal schwannomas. Cancers (Basel) 13(6):1310

Agarwal A (2015) Intracranial trigeminal schwannoma. Neuroradiol J 28(1):35–41CrossRef

Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O’Neill N (2020) The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasESeries in Surgery (PROCESS) Guidelines. Int J Surg 84:231–235CrossRefPubMed

Al-Mefty O, Ayoubi S, Gaber E (2002) Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg 96(3):453–463CrossRefPubMed

Alyousif A, Almolani F, Almomen A (2020) Endonasal endoscopic removal of a large intracranial infratemporal fossa trigeminal schwannoma: A case report and literature review. Otolaryngol Case Rep 17:100220CrossRef

Arseni C, Dumitrescu L, Constantinescu A (1975) Neurinomas of the trigeminal nerve. Surg Neurol 4(6):497–503PubMed

Bordi L, Compton J, Symon L (1989) Trigeminal neuroma. A report of eleven cases. Surg Neurol 31(4):272–276CrossRefPubMed

10.

Bulsara KR, Al-Mefty O (2004) Skull base surgery for benign skull base tumors. J Neurooncol 69(1–3):181–189CrossRefPubMed

11.

Campero A, Baldoncini M, Román G, Villalonga JF (2021) Double-stage complete removal of dumbbell-shaped trigeminal schwannoma: 3-dimensional operative video. Oper Neurosurg (Hagerstown) 21(1):E51CrossRefPubMed

12.

Chen LF, Yang Y, Yu XG et al (2014) Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases. Acta Neurochir (Wien) 156(6):1105–1114CrossRefPubMed

13.

Dolenc VV (1994) Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien) 130(1):55–65CrossRefPubMed

14.

Feroze KB, Patel BC. Neurotrophic keratitis (2023) In: StatPearls. Treasure Island (FL): StatPearls Publishing

15.

Goel A, Muzumdar D, Raman C (2003) Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery 52(4):783–790CrossRefPubMed

16.

Hasegawa T, Kato T, Iizuka H, Kida Y (2013) Long-term results for trigeminal schwannomas treated with gamma knife surgery. Int J Radiat Oncol Biol Physics 87(5):1115–1121CrossRef

17.

Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH (2010) The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 113(5):967–974CrossRefPubMed

18.

Jeong SK, Lee EJ, Hue YH, Cho YH, Kim JH, Kim CJ (2014) A suggestion of modified classification of trigeminal schwannomas according to location, shape, and extension. Brain Tumor Res Treat 2(2):62–68CrossRefPubMedPubMedCentral

19.

Jusué-Torres I, Martinez-Gutierrez JC, Elder BD, Olivi A (2015) Giant trigeminal schwannoma presenting with obstructive hydrocephalus. Cureus 7(11):e386PubMedPubMedCentral

20.

Kassam AB, Prevedello DM, Carrau RL et al (2009) The front door to meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 64(3 Suppl):ons71–ons82; discussion ons82–ons83

21.

Kouyialis AT, Stranjalis G, Papadogiorgakis N et al (2007) Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae. Acta Neurochir (Wien) 149(9):959–964CrossRefPubMed

22.

MacNally SP, Rutherford SA, Ramsden RT, Evans DG, King AT (2008) Trigeminal schwannomas. Br J Neurosurg 22(6):729–738CrossRefPubMed

23.

Mariniello G, Cappabianca P, Buonamassa S, de Divitiis E (2004) Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach. Clin Neurol Neurosurg 106(2):104–109CrossRefPubMed

24.

McCormick PC, Bello JA, Post KD (1988) Trigeminal schwannoma: Surgical series of 14 cases with review of the literature. J Neurosurg 69(6):850–860CrossRefPubMed

25.

Neves MWF, de Aguiar PHP, Belsuzarri TAB, de Araujo AMS, Paganelli SL, Maldaun MVC (2019) Microsurgical management of trigeminal schwannoma: cohort analysis and systematic review. J Neurol Surg B Skull Base 80(3):264–269CrossRefPubMed

26.

Niranjan A, Barnett S, Anand V, Agazzi S (2016) Multimodality management of trigeminal schwannomas. J Neurol Surg B Skull Base 77(4):371–378CrossRefPubMedPubMedCentral

27.

Paillas JE, Grisoli F, Farnarier P (1974) Trigeminal nerve neurinomas. Apropos of 8 cases. Neurochirurgie 20(1):41–54PubMed

28.

Peciu-Florianu I, Régis J, Levivier M, Dedeciusova M, Reyns N, Tuleasca C (2021) Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis. Neurosurg Rev 44(5):2391–2403CrossRefPubMed

29.

Ramina R, Mattei TA, Sória MG et al (2008) Surgical management of trigeminal schwannomas. Neurosurg Focus 25(6):E6CrossRefPubMed

30.

Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH (2014) Surgical management of trigeminal schwannomas: defining the role for endoscopic endonasal approaches. Neurosurg Focus 37(4):E17CrossRefPubMed

31.

Rodriguez Rubio R, Chae R, Vigo V, Abla AA, McDermott M (2019) Immersive surgical anatomy of the pterional approach. Cureus 11(7):e5216PubMedPubMedCentral

32.

Samii M, Alimohamadi M, Gerganov V (2014) Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas. Neurosurgery 10(Suppl 4):565–575PubMed

33.

Schisano G, Olivecrona H (1960) Neurinomas of the gasserian ganglion and trigeminal root. J Neurosurg 17(2):306–322CrossRefPubMed

34.

Sheikh MM, De Jesus O (2022) Schwannoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing

35.

Taha JM, Tew JM, Jr., van Loveren HR, Keller JT, el-Kalliny M (1995) Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 82(5):719–725

36.

Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH (2012) Trigeminal schwannomas: skull base approaches and operative results in 105 patients. Oper Neurosurg (Hagerstown) 70:ons132–ons144

37.

Wu X, Xie SH, Tang B et al (2021) Single-stage endoscopic endonasal approach for the complete removal of trigeminal schwannomas occupying both the middle and posterior fossae. Neurosurg Rev 44(1):607–616CrossRefPubMed

38.

Yang A, Kunigelis K, Youssef AS (2018) Retrosigmoid approach to the posterior fossa trigeminal schwannoma. J Neurol Surg B Skull Base 79(Suppl 5):S393–S394PubMedPubMedCentral

39.

Yasui T, Hakuba A, Kim SH, Nishimura S (1989) Trigeminal neurinomas: operative approach in eight cases. J Neurosurg 71(4):506–511CrossRefPubMed

40.

Yoshida K, Kawase T (1999) Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 91(2):202–211CrossRefPubMed

41.

Youssef S, Kim EY, Aziz KM, Hemida S, Keller JT, van Loveren HR (2006) The subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas: cadaveric prosection. Neurosurgery 59(4 Suppl 2):ons270–ons277; discussion ons277–ons278

42.

Zhang Q, Feng K, Ge C, Hongchuan G, Mingchu L (2012) Endoscopic endonasal management of trigeminal schwannomas extending into the infratemporal fossa. J Clin Neurosci 19(6):862–865CrossRefPubMed

43.

Zhang L, Yang Y, Xu S, Wang J, Liu Y, Zhu S (2009) Trigeminal schwannomas: A report of 42 cases and review of the relevant surgical approaches. Clin Neurol Neurosurg 111(3):261–269CrossRefPubMed

Title: Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series
Authors: Matthew C. Findlay
Michael T. Bounajem
Vance Mortimer
Karol P. Budohoski
Robert C. Rennert
William T. Couldwell
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Schwannoma
Craniotomy
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-06094-y

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Springer Medicine

Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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