Facial and lower cranial nerve function preservation in lateral approach for craniocervical schwannomas

Abstract

The purpose of this study was to discuss surgical approach selection, surgical procedures, and treatment strategy for preservation of the facial and lower cranial nerve function in craniocervical schwannomas surgery. Between 2002 and 2011, 44 craniocervical schwannomas were operated in Xinhua hospital of Shanghai, China by the same surgical team. The records were reviewed retrospectively regarding clinical presentation, radiographic assessment, surgical approaches selection, surgical procedures and facial and lower cranial nerve follow-up outcomes. Headache or neck pain was present in 30 patients (68.2 %) and cervical mass in 9 patients (20.5 %). Cranial nerve impairments, mainly involving the vagus nerve, were present in 19 patients (43.2 %) and hypoglossal nerve in five patients (11.4 %). 22 tumors were intra- and extracranial, 10 were intra-cranial and 12 were extra-cranial. According to the tumor region, infratemporal fossa type A approach, petrous occipital transsigmoid approach and transcervial approach were selected for tumor removal. Gross-total resection was achieved in 40 patients (90.9 %). Adjunctive radiosurgery was used in the management of residual tumor in two patients; tumor control was ultimately obtained in all cases. During follow-up period, good facial function was obtained in 42 patients (95.5 %) and complete compensation of lower cranial nerve function was achieved in all patients. The preoperative estimation of tumor in nature is of great importance in the determination of proper surgical planning of craniaocervical schwannomas. Facial nerve and lower cranial nerve function can be preserved in maximal degree by proper surgical approaches and careful operative manipulation. Initial surgical resection followed by radiosurgery may be an effective option for some special patients.