Abstract
Trigeminal schwannomas (TSs) are rare, slow-growing tumors that account for less than 0.5% of all intracranial tumors. After the vestibular nerve, the trigeminal nerve (cerebellopontine angle) and the Gasserian ganglion (cavernous sinus and Meckel’s cave) are the most common sites for intracranial schwannomas. The clinical presentation of trigeminal schwannoma depends on the size and location of the tumor. Typical symptoms include ipsilateral hypesthesia, headache, and facial pain. Diagnosis is usually made according to clinical features and imaging findings. The most definitive treatment for TSs is microsurgical removal, especially for large tumors with significant mass effect on the brainstem. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at a well-established skull base neurosurgical center. Although good results have been reported with radiosurgery, patients should be informed of the risk of recurrence and the limited symptomatic relief that it provides. Familiarity with a wide variety of skull base approaches and the advantages and limitations of each approach is critical for the successful microsurgical treatment of trigeminal schwannomas.
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Abbreviations
- CN:
-
cranial nerve
- CP:
-
cerebellopontine
- CSF:
-
cerebrospinal fluid
- CT:
-
computed tomography
- CTA:
-
computed tomography angiography
- MR:
-
magnetic resonance
- SRS:
-
stereotactic radiosurgery
- TS:
-
trigeminal schwannoma
References
Neves MWF, de Aguiar PHP, Belsuzarri TAB, de Araujo AMS, Paganelli SL, Maldaun MVC. Microsurgical management of trigeminal schwannoma: cohort analysis and systematic review. J Neurol Surg B. 2019;80:264–9.
Jusué-Torres I, Martinez-Gutierrez JC, Elder BD, Olivi A. Giant trigeminal schwannoma presenting with obstructive hydrocephalus. Cureus. 2015;7:e386.
Peker S, Bayrakli F, Kiliç T, Pamir MN. Gamma-knife radiosurgery in the treatment of trigeminal schwannomas. Acta Neurochir. 2007;149:1133–7.
Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemomas of the trigeminal nerve. J Neurosurg. 1989;70:737–45.
Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clin Neurosurg. 1955;1:11–54.
Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52:783–90. discussion 790
Guthikonda B, Theodosopoulos PV, van Loveren H, Tew JM Jr, Pensak ML. Evolution in the assessment and management of trigeminal schwannoma. Laryngoscope. 2008;118:195–203.
Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas. J Neurosurg. 1995;82:711–8.
Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg. 1999;91:202–11.
Neff BA, Carlson ML, O’Byrne MM, Van Gompel JJ, Driscoll CLW, Link MJ. Trigeminal neuralgia and neuropathy in large sporadic vestibular schwannomas. J Neurosurg. 2017;127:992–9.
Peciu-Florianu I, Régis J, Levivier M, Dedeciusova M, Reyns N, Tuleasca C. Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis. Neurosurg Rev. 2020;44(5):2391–403. https://doi.org/10.1007/s10143-020-01433-w.
Makarenko S, Ye V, Akagami R. Natural history, multimodal management, and quality of life outcomes of trigeminal schwannomas. J Neurol Surg B Skull Base. 2018;79:586–92.
Samii M, Alimohamadi M, Gerganov V. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminalschwannomas. Neurosurgery. 2014;10(Suppl4):565–75. discussion 575
Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH. Surgical management of trigeminal schwannomas: defining the role for endoscopic endonasal approaches. Neurosurg Focus. 2014;37:E17.
Park HH, Hong SD, Kim YH, Hong C-K, Woo KI, Yun I-S, Kong D-S. Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg. 2020;133:467–76.
Di Somma A, Langdon C, de Notaris M, Reyes L, Ortiz-Perez S, Alobid I, Enseñat JJ. Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel’s cave schwannoma: technical nuances of a mini-invasive, multiportal approach. Neurosurgery. 2020;134(6):1836–45.
Raza SM, Amine MA, Anand V, Schwartz TH. Endoscopic endonasal resection of trigeminal schwannomas. Neurosurg Clin N Am. 2015;26:473–9.
Champ CE, Mishra MV, Shi W, Siglin J, Werner-Wasik M, Andrews DW, Evans JJ. Stereotactic radiotherapy for trigeminal schwannomas. Neurosurgery. 2012;71:270–7. discussion 277
Janjua RM, Wong KM, Parekh A, van Loveren HR. Management of the great mimicker: meckel cave tumors. Neurosurgery. 2010;67(2 Suppl Operative):416–21.
Sindou M, Messerer M, Alvernia J, Saint-Pierre G. Percutaneous biopsy through the foramen ovale for parasellar lesions: surgical anatomy, method, and indications. Adv Tech Stand Neurosurg. 2012;38:57–73.
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Huff, W., Hendricks, B.K., Cohen-Gadol, A.A. (2022). Trigeminal Schwannoma. In: Youssef, A.S. (eds) Contemporary Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-99321-4_29
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