Opinion statement
Nonvestibulocochlear cranial nerve schwannomas traditionally have been managed by surgical excision. Although debulking surgery is still considered the first treatment option for larger tumors, stereotactic radiosurgery is now preferred for smaller tumors because of its high tumor control rate and low treatment-related morbidity. Furthermore, an initial period of radiologic and clinical observation following the diagnosis should be strongly considered for smaller tumors because some may not grow or may grow at a slow rate. Medical management of tumor-associated symptoms (when present) should not be ignored. Most importantly, the time has come to embark on the first randomized controlled trials comparing clinical and radiologic observation, surgery, and radiosurgery in the management of cranial nerve schwannomas.
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References and Recommended Reading
• McClatchey AI: Neurofibromatosis. Annu Rev Pathol 2007, 2:191–216. This is a comprehensive review of the current genetic and clinical understanding of neurofibromatosis.
Feinberg AS, Newman N: Schwannoma in patients with isolated unilateral trochlear nerve palsy. Am J Ophthalmol 1999:183–188.
Mrugala MM, Batchelor TT, Plotkin SR: Peripheral and cranial nerve sheath tumors. Curr Opin Neurol 2005, 18:604–610.
Fisher LM, Doherty JK, Lev MH, Slattery WH 3rd: Distribution of nonvestibular cranial nerve schwannomas in neurofibromatosis 2. Otol Neurotol 2007, 28:1083–1090.
Sarma S, Sekhar LN, Schessel DA: Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery 2002, 50:437–448.
McMonagle D, Al-Sanosi A, Groxson G, et al.: Facial schwannoma: results of a large case series and review. J Laryngol Otol 2008, 122:1139–1150.
Elmalem VI, Younge BR, Biousse V, et al.: Clinical course and prognosis of trochlear nerve schwannomas. Ophthalmology 2009, 116:2011–2016.
Ohba S, Miwa T, Kawase T: Trochlear nerve schwannoma with intratumoral hemorrhage: case report. Neurosurgery 2006;58:E791.
Mulkens TH, Parizel PM, Martin JJ, et al.: Acoustic schwannoma: MR findings in 84 tumors. AJR Am J Roentgenol 1993, 160:395–398.
Doherty JK, Friedman RA: Controversies in building a management algorithm for vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg 2006, 14:305–313.
Martin TPC, Tzifa K, Kowalski C, et al.: Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation. Clin Otolaryngol 2008, 33:228–235.
• Hajioff D, Raut VV, Walsh RM, et al.: Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008, 33:255–264. This prospective study of conservative management of vestibulocochlear schwannomas found that 35% to 40% of patients required intervention at a median of 37 months.
Schisano G, Olivecrona H: Neurinomas of the gasserian ganglion and trigeminal root. J Neurosurg 1960, 17:306–322.
Goel A, Muzumdar D, Raman C: Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery 2003, 52:783–790.
Day JD, Fukushima T: The surgical management of trigeminal neuromas. Neurosurgery 1998, 42:233–240.
Sharma BS, Ahmad FU, Chandra PS, et al.: Trigeminal schwannomas: experience with 68 cases. J Clin Neurosci 2008, 15:738–743.
Franzin A, Vimercati A, Medone M, et al.: Neuroophthalmological evaluation after Gamma Knife surgery for cavernous sinus meningiomas. Neurosurg Focus 2007, 23(6):E10.
Kondziolka D, Nathoo N, Flickinger JC, et al.: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 2003, 53:815–822.
Chopra R, Kondziolka D, Niranjan A, et al.: Long term follow up of acoustic schwannoma radiosurgery with marginal doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2007, 68:845–851.
Mack A, Scheib S, Major J, et al.: Precision dosimetry for narrow photon beams used in radiosurgery—determination of Gamma Knife output factors. Med Phys 2002, 29:2080–2089.
Hamm KD, Gross MW, Fahrig A, et al.: Stereotactic radiotherapy for the treatment of nonacoustic schwannomas. Neurosurgery 2008, 62:A29–A36.
Pollock BE, Foote RL, Stafford SL: Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys 2002, 52:1002–1007.
•• Showalter TN, Werner-Wasik M, Curran WJ, et al.: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery 2008, 63:734–740.
Petrela E, Hodge CJ, Hahn SS, et al.: Stereotactic radiosurgery in two cases of presumed fourth cranial nerve schwannoma. J Neuroophthalmol 2009, 29:54–57.
Sakamoto GT, Borchers DJ, Xiao F, et al.: CyberKnife radiosurgery for trigeminal schwannomas. Neurosurgery 2009, 64:A14–A18.
Madhok R, Kondziolka D, Flickinger JC, et al.: Gamma knife radiosurgery for facial schwannomas. Neurosurgery 2009, 64:1102–1105.
Guthikonda B, Theodosopoulos PV, van Loveren H: Evolution in the assessment and management of trigeminal schwannoma. Laryngoscope 2008, 118:195–203.
Prasad S, Galetta S: Trigeminal neuralgia, historical notes and current concepts. Neurologist 2009, 15:87–94.
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Mejico, L.J. Nonvestibulocochlear Cranial Nerve Schwannomas. Curr Treat Options Neurol 12, 37–42 (2010). https://doi.org/10.1007/s11940-009-0053-1
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DOI: https://doi.org/10.1007/s11940-009-0053-1