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

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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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Data availability

All data are presented in this report.

Code availability

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Acknowledgements

We thank Kristin Kraus, MSc, for editorial support.

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Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA

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

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  1. Matthew C. Findlay
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  2. Michael T. Bounajem
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  3. Vance Mortimer
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Contributions

MCF: data collection, data analysis, manuscript production; MTB: data collection, editing; RCR: data collection, video production, manuscript production; VM: video production; KPB: data collection, editing; WTC: editing, video production.

Corresponding author

Correspondence to William T. Couldwell.

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This work was performed with the approval of the University of Utah institutional review board with a waiver of informed consent.

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The patient consented to participate.

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The patient consented to the publication of this case and video.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (MP4 419283 KB) Supplemental Video 1: Left frontotemporal craniotomy for resection of a giant trigeminal schwannoma

Supplementary file 2 (MP4 432377 KB) Supplemental Video 2: Staged intracranial and transmaxillary approach for resection of a giant trigeminal schwannoma

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Findlay, M.C., Bounajem, M.T., Mortimer, V. et al. Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series. Acta Neurochir 166, 198 (2024). https://doi.org/10.1007/s00701-024-06094-y

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