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Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve

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Abstract

Objective

To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve.

Methods

A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded.

Results

This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved.

Conclusion

Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

Beijing Municipal Administration of Hospitals Incubating Program (PX2018024).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Liang-Peng Chen, Da Li, Xiao-Jie Li, Lai-Rong Song, Li-Wei Zhang, Zhen Wu, Jun-Ting Zhang & Liang Wang

  2. Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China

    Liang-Peng Chen, Da Li, Xiao-Jie Li, Lai-Rong Song, Li-Wei Zhang, Zhen Wu, Jun-Ting Zhang & Liang Wang

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  1. Liang-Peng Chen
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Correspondence to Jun-Ting Zhang or Liang Wang.

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Ethical approval was obtained from the Beijing Tiantan Hospital Research Ethics Committee (KY-2019–071-01).

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Chen, LP., Li, D., Li, XJ. et al. Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve. Acta Neurochir 165, 2885–2893 (2023). https://doi.org/10.1007/s00701-023-05735-y

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