Surgical management of trigeminal schwannomas.
OBJECTIVE
The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension.


METHODS
A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year.


RESULTS
Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively.


CONCLUSIONS
The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.
Ramina
Ricardo
R
Department of Neurosurgery, Instituto de Neurologia de Curitiba, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Mattei
Tobias A
TA
Sória
Marília G
MG
da Silva
Erasmo B
EB
Leal
André G
AG
Neto
Maurício C
MC
Fernandes
Yvens B
YB
D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D020433:Trigeminal Nerve Diseases / Q000473:pathology / Q000601:surgery*