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Ribeiro FV, Sousa MP, Palavani LB, Andreão FF, Neto AR, Pereira MAOM, Fukunaga CK, Fabrini Paleare LF, Montecino LM, Cabral Júnior SG, Brenner LO, Ferreira MY, Brito HN. Endonasal endoscopic surgical approach for treating trigeminal schwannomas: A systematic review and meta-analysis. Neurochirurgie 2025; 71:101676. [PMID: 40354891 DOI: 10.1016/j.neuchi.2025.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 04/06/2025] [Accepted: 05/02/2025] [Indexed: 05/14/2025]
Abstract
INTRODUCTION Trigeminal schwannomas (TSs) are the second most common type of intracranial schwannoma. Surgical approaches are chosen depending on the type of tumor extension. The middle fossa extradural approach, infratemporal extradural approach, transmaxillary approach, transmandibular approach, and transcervical approach have been used. However, these approaches are associated with a variety of complications including other cranial nerve dysfunction. Recently, with the wide application of endoscopic technology, the endoscopic endonasal approach (EEA) seems to be an alternative skull base surgical approach for skull base pathology. OBJECTIVE The objective of the present study is to evaluate the safety and efficacy EEA approach for TSs. METHODS We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals (CI) under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with the endoscopic endonasal approach for trigeminal schwannomas. RESULTS Of the 2550 initially identified studies, 9 were selected, involving 195 patients, with a median follow-up of 36 months. The combined analysis showed a 29% (CI: 11%-49%) partial resection rate, while a pooled analysis for complete resection demonstrated an 84% rate (CI: 68%-99%). Preservation of cranial nerves reached a 99% rate (CI: 96%-100%) with a 100% preservation of facial function rate (CI: 97%-100%) and a 5% complications rate (CI: 0%-13%). CONCLUSION Based on these findings, our meta-analysis identified that the endonasal endoscopic approach for the treatment of trigeminal schwannomas presents a low rate of complications, favorable results regarding the preservation of facial function and cranial nerves, and, a high rate of effectiveness, demonstrated by the results of complete resection.
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Affiliation(s)
| | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ary Rodrigues Neto
- Faculty of Medicine Multivix, Cachoeiro de Itapemirim, Espírito Santo, Brazil
| | | | | | | | - Laura Mora Montecino
- Faculty of Medical Sciences, Metropolitan University of Barranquilla, Barranquilla, Colombia
| | | | | | - Marcio Yuri Ferreira
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Herika Negri Brito
- Department of Neurosurgery, Mayo Clinic Hospital, Phoenix, AZ, United States
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Tanji M, Sano N, Hashimoto J, Kikuchi M, Matsunaga M, Kitada Y, Yamamoba M, Takeuchi Y, Makino Y, Hattori EY, Terada Y, Mineharu Y, Arakawa Y. Multiport combined endoscopic endonasal and transorbital approach to orbital schwannoma. Surg Neurol Int 2025; 16:98. [PMID: 40206748 PMCID: PMC11980739 DOI: 10.25259/sni_246_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 11/27/2024] [Indexed: 04/11/2025] Open
Abstract
Background We present a case report describing the use of combined endoscopic endonasal and transorbital approach (EETOA) for intraorbital schwannoma that grew rapidly during pregnancy. Case Description A 27-year-old woman who presented with headache was incidentally diagnosed with a tumor mass 1 cm in diameter near the right superior orbital fissure. Treatment of the tumor was deferred to follow-up. One month later, the patient became pregnant, and in the last trimester, she developed right abducens palsy and mildly dilated pupil. Magnetic resonance imaging (MRI) showed that the tumor mass had grown rapidly with a maximal diameter of 5 cm and had extended into the orbit through the superior orbital fissure. After spontaneous vaginal delivery, EETOA was planned to remove both the intraorbital region and cavernous sinus compartment to avoid craniotomy. Surgical resection began with an endoscopic endonasal approach. Orbital decompression was performed by removing the lamina papyracea, and the tumor was resected in the lateral cavernous sinus compartment. An eyebrow incision was made, and endoscopic transorbital surgery was performed to remove the intraorbital region. Multi-perspective views during EETOA enabled gross total resection of the tumor and confirmed by intraoperative MRI. The pathological diagnosis was schwannoma. The patient's abducens nerve palsy improved after surgery. Conclusion EETOA can offer maximal exposure and resection for tumors extending from the cavernous sinus to the orbit without craniotomy in selected cases.
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Affiliation(s)
- Masahiro Tanji
- Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noritaka Sano
- Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Jun Hashimoto
- Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mami Matsunaga
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Kitada
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Maki Yamamoba
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhide Takeuchi
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhide Makino
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Yukinori Terada
- Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Xiao Q, Peng H, Tang G, Yuan J, Peng G, Zhang C, Wang X, Huang W, Qin C, Liu Q. Individual surgical management of trigeminal schwannomas guided by an extended classification: a consecutive series of 96 clinical cases at a single institution. Neurosurg Rev 2025; 48:289. [PMID: 40059120 PMCID: PMC11891104 DOI: 10.1007/s10143-025-03404-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 01/20/2025] [Accepted: 02/09/2025] [Indexed: 05/13/2025]
Abstract
Trigeminal schwannoma (TS) is a rare intracranial neurinoma that affects the multicompartmental skull base. In recent decades, advancements in skull-base neurosurgical techniques and endoscopic surgery have significantly improved outcomes for TS patients. In this study, we present our experience with surgical resection of TS using a further classification system. We conducted a retrospective analysis of the clinical, surgical, and follow-up data of 96 patients diagnosed with TS at our institution between March 2012 and June 2022. The tumors were classified based on the MPE classification, with Type M further divided into M1 and M2 subtypes according to the origin of the tumor and the patterns of cavernous sinus (CS) invasion. Type MP tumors were divided into M1P and M2P subtypes based on whether the tumors in the middle cranial fossa extended into the anterior CS. Optimal surgical approaches were proposed for each subtype. The outcomes of the case series were collected and analyzed. Based on the further MPE classification, 32 tumors were classified as Type M2P, 21 as Type M1P, 12 as Type ME, 8 as Type P, 8 as Type M1, 8 as Type MPE, and 7 as Type M2. Gross total resection (GTR) was achieved in 88 patients, while five patients underwent subtotal resection (STR), and three patients received partial resection (PR). No deaths occurred during the perioperative period. The extended MPE classification provides specific insights into the features of TS involving the middle fossa, enabling more individualized and tailored treatment strategies, as well as appropriate approach selection. The combination of microsurgery, endoscopic surgery, and stereotactic radiotherapy can lead to satisfactory outcomes in managing complex TS, achieving high rates of GTR while minimizing complications.
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Affiliation(s)
- Qun Xiao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Peng
- Department of Neurosurgery, Hainan Second People's Hospital, Hainan, China
- Department of Neurosurgery, Hainan Affifiliated Hospital of Hainan Medical University, Hainan, China
| | - Guodong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Gang Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chi Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Weicheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chaoying Qin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
| | - Qing Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
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Jiang JY, Leu YS, Wang YP, Chan YK, Chen TY. A Giant Schwannoma Extending from Medial Portion of Middle Cranial Fossa to Parapharyngeal Space and Deep Parotid Space. EAR, NOSE & THROAT JOURNAL 2024; 103:NP710-NP713. [PMID: 35349782 DOI: 10.1177/01455613221086031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Trigeminal schwannomas are rare tumours comprising 0.2% of all intracranial tumours and 0.5% of all head and neck tumours. Patients with trigeminal schwannomas presented with facial hypoesthesia and pain. We presented a case with left bulging oropharynx. The CT scan showed a 3.8x2.6x4.9cm left parapharyngeal tumour compressed to the oropharynx and middle cranial fossa. We performed 3 ways in two times of operation to excise the whole tumour. We chose the transoral approach for parapharyngeal space, trans-parotid approach for deep parotid part and the endoscopic endonasal trans-pterygoid approach and trans-maxillary with Canine fossa trephination for intracranial lesions. The pathology showed schwannoma. A huge schwannoma extended from intracranial to several spaces is difficult to resect just by one approach. We should separate the tumour to several parts by clinical image before the operation and design a plan to remove the whole tumour in different approach. The different space of tumour involvement had several ways to access. We needed to choose the less harm but with better surgical field.
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Affiliation(s)
- Jing-Yi Jiang
- Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taiwan
| | - Ying-Piao Wang
- Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taiwan
- School of Medicine, MacKay Medical College, Taiwan
| | - Yun-Kai Chan
- Division of Neurosurgery, Department of Surgery, MacKay Memorial Hospital, Taiwan
| | - Tung-Ying Chen
- Department of Pathology, MacKay Memorial Hospital, Taiwan
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Sasaki T, Morisako H, Beniwal M, Ikeda S, Nagahama A, Ikegami M, Ohata K, Goto T. Purely Endoscopic Subtemporal Keyhole Approach for Trigeminal Schwannomas: Surgical Techniques and Early Results. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01426. [PMID: 39584841 DOI: 10.1227/ons.0000000000001465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/26/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In the past, microscopic transcranial approach was the mainstay of treatment of trigeminal schwannomas. In recent years, several endoscopic procedures have been reported for trigeminal schwannomas. For trigeminal schwannomas arising around the Meckel cave, we introduced a fully endoscopic procedure with a small temporal craniotomy in June 2020 and have performed radical tumor removal as in the conventional approach. This article describes the details of the purely endoscopic subtemporal keyhole approach (PESKA) surgical procedure and reports the initial surgical results. METHODS Between June 2020 and November 2023, 8 cases of trigeminal schwannoma were treated with PESKA. The mean tumor diameter was 33.1 mm. The surgical procedure for PESKA consists of a 7-cm linear skin incision made upward from the anterior to the auricle on the side of the lesion, followed by a 4-cm temporal craniotomy and then endoscopic manipulation. The intradural part of the middle cranial fossa is observed, and the Meckel cave is identified and opened. The tumor is removed with preserving most normal trigeminal nerve fibers. The site of the lesion, the extent of resection, complications, operative time, Karnofsky Performance Status, and intraoperative blood loss were evaluated. RESULTS All 8 patients underwent gross total resection. Only one patient had new temporal edema on the side of the lesion, which was asymptomatic. The mean operative time was 4 hours and 21 minutes. CONCLUSION We report on PESKA, a fully endoscopic procedure with a small temporal craniotomy for a trigeminal schwannoma arising around the Meckel cave. The use of an endoscope allowed for a wide field of view, even in a narrow operative field, reducing brain traction and allowing radical resection of the tumor while preserving normal trigeminal nerve fibers. This method may represent an effective surgical alternative for trigeminal schwannomas.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Manish Beniwal
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Shohei Ikeda
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Atsufumi Nagahama
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masaki Ikegami
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Choucha A, Troude L, Morin L, Fernandes S, Baucher G, De Simone M, Lihi A, Mazen K, Alseirihi M, Passeri T, Gay E, Fournier HD, Jacquesson T, Jouanneau E, Froelich S, Roche PH. Management of large Trigeminal Schwannoma: long-term oncologic and functional outcome from a multicentric retrospective cohort. Acta Neurochir (Wien) 2024; 166:440. [PMID: 39499407 DOI: 10.1007/s00701-024-06292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 09/06/2024] [Indexed: 11/07/2024]
Abstract
OBJECTIVE Trigeminal schwannoma (TS), though a rare and benign tumor, becomes a significant surgical challenge due to its intricate location. This study aims to detail the long-term functional outcomes and tumor control post-surgical resection. METHOD We analyzed a multicentric retrospective cohort of 39 patients operated on for a TS in five tertiary centers between January 1993 and July 2022. RESULTS Six TS (15%) were in the middle fossa (type M), two (5%) in the posterior fossa (type P), and two (5%) were extracranial (type E). Twenty-nine (75%) were Dumbbell shape: Eighteen (47%) were MP type, seven (18%) were MPE type, and four (10%) were ME type. Fifth nerve symptoms were the foremost preoperative complaint: hypesthesia (51%), trigeminal neuralgia (36%), and paresthesia (30%). We report a favorable evolution course for 61% of preexisting deficits (half of patients with preoperative paresthesia and neuralgia improved while only 5% of preoperative hypesthesia improved). Postoperative hypesthesia was the most frequent de novo deficit 14 (74%) and resolved in solely half the cases. Various approaches were used according to tumor type. Gross total resection (GTR), Subtotal resection (STR), and partial resection (PR) were achieved in respectively 33% (N = 13), 10% (N = 4), and 56% (N = 22) of patients. The mean clinical and radiological FU was 63 months (12 - 283 months). GTR led to no sign of recurrence (mean FU: 60 months - range: 12-283 months). For STR or PR (67%): 23 (88%) were assigned to a Wait-&-rescan policy (WS group) which offered stability in 70% (N = 16). Three cases (8%) underwent a complementary GKS (GammaKnife) on the residual lesion (GK group) without tumor change. CONCLUSION For large TS, the completeness of resection must consider the potential functional burden of surgery. With giant infiltrating lesions, a strategy of planned subtotal resection, complemented by radiosurgery, either complementary or uppon regrowth, may provide similar oncological outcomes.
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Affiliation(s)
- Anis Choucha
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France.
- Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, Marseille, France.
| | - Lucas Troude
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Laura Morin
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, |27 bd Jean Moulin cedex 05, Marseille, France
| | - Sarah Fernandes
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, |27 bd Jean Moulin cedex 05, Marseille, France
| | - Guillaume Baucher
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France
| | - Matteo De Simone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081, Baronissi, Italy
| | - Abir Lihi
- CHU Angers-Neurochirurgie, 4, rue Larrey, 49033, Angers Cedex 3, France
- Faculté de Médecine, Laboratoire d'Anatomie, Université Angers, rue Haute de Reculée, 49045, Angers, France
| | - Kallel Mazen
- Neurosurgery Unit, CHU Grenoble-Alpes, Grenoble, France
| | - Motaz Alseirihi
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Emmanuel Gay
- Neurosurgery Unit, CHU Grenoble-Alpes, Grenoble, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Henri-Dominique Fournier
- CHU Angers-Neurochirurgie, 4, rue Larrey, 49033, Angers Cedex 3, France
- Faculté de Médecine, Laboratoire d'Anatomie, Université Angers, rue Haute de Reculée, 49045, Angers, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Timothée Jacquesson
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Emmanuel Jouanneau
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
- French Society of Neurosurgery - Skull Base S, Paris, France
| | - Pierre-Hugues Roche
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France
- French Society of Neurosurgery - Skull Base S, Paris, France
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Shibao S, Yoshida K, Ueda R, Toda M. Risk factors of postoperative trigeminal neuropathy in surgical treatment of trigeminal schwannomas. Acta Neurochir (Wien) 2024; 166:387. [PMID: 39340670 DOI: 10.1007/s00701-024-06261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/25/2024] [Indexed: 09/30/2024]
Abstract
OBJECTIVE Trigeminal schwannomas are rare benign tumors originating from the Schwann cells of the trigeminal nerve. Despite the common occurrence of trigeminal neuropathy in trigeminal schwannomas, a detailed analysis has not yet been performed because of the rarity of this disease. This study aimed to analyze trigeminal neuropathy in trigeminal schwannoma resection and identify the risk factors for postoperative worsening of trigeminal neuropathy. METHODS A retrospective analysis of 86 surgical cases was performed at our institution between 1975 and 2018. Obtained parameters included age, sex, diagnosis, reoperation, tumor size, tumor location, presence or absence of cysts, surgical approach, degree of tumor removal, and pre/postoperative trigeminal neuropathy. Uni- and multivariate analyses were performed to identify the risk factors for worsening postoperative sensory disturbances. RESULTS Of 83 patients, 58.1% had preoperative trigeminal neuropathy. Postoperative sensory disturbance occurred in 27.9%, with worsening in two cases and de novo symptoms in 22 cases. Regarding risk factors for worsening postoperative sensory disturbances, older age, smaller tumor size, middle and posterior (MP) type, gross total removal (GTR), and anterior transpetrosal approach were identified in the univariate analysis, while MP type and GTR were identified in the multivariate analysis. CONCLUSIONS This study analyzed trigeminal neuropathy in trigeminal schwannomas in detail and identified tumor location and removal rate as risk factors for worsening postoperative sensory disturbances. Treatment strategies to reduce the risk of trigeminal neuropathy should be considered.
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Affiliation(s)
- Shunsuke Shibao
- Department of Neurosurgery, Dokkyo Mednical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ryo Ueda
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Nandoliya KR, Vignolles-Jeong J, Karras CL, Govind S, Finger G, Thirunavu V, Sonabend AM, Magill ST, Prevedello DM, Chandler JP. Clinical characteristics and outcomes after trigeminal schwannoma resection: a multi-institutional experience. Neurosurg Rev 2024; 47:340. [PMID: 39023629 DOI: 10.1007/s10143-024-02550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
Given their rarity, the clinical course of patients undergoing trigeminal schwannoma (TS) resection remains understudied. The objective of this study is to describe clinical characteristics and outcomes in patients undergoing surgical resection for TS in a multi-institutional cohort. This is a retrospective study of patients undergoing TS resection at two institutions between 2004 and 2022. Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods. Thirty patients were included. The median patient age was 43 (IQR: 35-52) years, and 14 (47%) patients were female. Median clinical and radiographic follow-ups were 43 (IQR: 20-81) and 47 (IQR: 27-97) months respectively. The most common presenting symptoms were trigeminal hypesthesia (57%) and headaches (30%), diplopia (30%), and ataxia/cerebellar signs (30%). The median maximum tumor diameter was 3.3 (IQR: 2.5-5.4) cm. Most tumors were Samii type C (50%) and mixed cystic-solid (63%). Surgical approaches included endoscopic endonasal (33%), supratentorial (30%), combined/staged (20%), infratentorial (10%), and anterior petrosal (7%) approaches. Gross-total resection was achieved in 16 (53%) patients. Radiographic tumor recurrence was noted in four patients at a median of 79 (range 5-152) months. Twenty-six (87%) patients reported improvements in at least one symptom by last follow-up. The most common perioperative complication was new cranial nerve deficit, with 17% of patients having a transient deficit and 10% having a permanent cranial nerve deficit. Surgical resection of TS showed good progression-free survival and symptom improvement, but was associated with cranial nerve deficits.
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Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Joshua Vignolles-Jeong
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, USA
| | - Constantine L Karras
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Sachin Govind
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
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De Simone M, Choucha A, Dannhoff G, Kong DS, Zoia C, Iaconetta G. Treating Trigeminal Schwannoma through a Transorbital Approach: A Systematic Review. J Clin Med 2024; 13:3701. [PMID: 38999267 PMCID: PMC11242079 DOI: 10.3390/jcm13133701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Trigeminal schwannomas (TSs) are uncommon tumors found along any segment of the fifth cranial nerve (CN V). Typically located at the skull base, these benign tumors carry substantial morbidity due to the extent of traditional surgical methods. Minimally invasive endoscopic surgery such as the endoscopic transorbital approach (ETOA) presents promising new avenues for treatment, with the transorbital approach emerging as a potentially successful alternative. Methods: This review systematically assesses the application of the ETOA in treating TSs. PubMed, Ovid MEDLINE, and Embase were thoroughly searched for articles detailing the use of the ETOA in clinical case studies. The outcomes of interest encompassed epidemiological profiling, surgical results, and complication rates. Results: This study included 70 patients with TSs (from six studies), with 22 males (31.4%) and 58 females (68.6%). Patients averaged 55 years and were monitored for around 16.4 months (on average). In most tumors, the middle cranial fossa was involved to some degree. The majority (87.2%) were large (3-6 cm) and underwent gross total resection (GTR) or near-total resection in 87.2% of patients. Preoperatively, sensory alterations were common, along with proptosis, neuropathic pain, and diplopia. Postoperatively, complications included ptosis, diplopia, sensory impairment, corneal keratopathy, masticatory difficulty, and neuralgia. The pure ETOA was the primary surgical technique used in 90% of cases, with no recurrence observed during the follow-up period. Conclusions: Using the ETOA to treat TSs demonstrated an oncologic control rate of 87.2%. Postoperative complications including ptosis, diplopia, and sensory disturbances have been observed, but careful monitoring and management can mitigate these problems. The ETOA emerges as a viable surgical option, especially for tumors involving the middle cranial fossa, capable of adapting to individual patient needs and demonstrating efficacy in TS management.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
- BrainLab s.r.l., Mercato San Severino, 84085 Salerno, Italy
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France
- Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, 13005 Marseille, France
| | - Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 03063, Republic of Korea
| | - Cesare Zoia
- UOC of Neurosurgery, Ospedale Moriggia Pelascini, Gravedona e Uniti, 22015 Gravedona, Italy
| | - Giorgio Iaconetta
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
- Neurosurgery Unit, University Hospital "San Giovanni di Dio e Ruggi, D'Aragona", 84131 Salerno, Italy
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10
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Mak YH, Ho G. Multicompartmental cystic trigeminal schwannoma as an uncommon differential diagnosis of cerebellopontine angle tumors. Radiol Case Rep 2024; 19:2552-2557. [PMID: 38596177 PMCID: PMC11001620 DOI: 10.1016/j.radcr.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Trigeminal schwannoma is the second most common intracranial schwannoma yet accounts for less than 0.5% intracranial tumors [1]. Cystic degeneration is uncommon. We would like to report a pathologically proven multicompartmental cystic trigeminal schwannoma in a young adult presenting with chronic headache. A literature review on the imaging features of trigeminal schwannoma is performed to assist radiologists in accurate disease localization and prioritizing differential diagnosis in challenging cases. Confident preoperative radiological diagnosis would directly affect management strategies.
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Affiliation(s)
- Yuen Hei Mak
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
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11
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Dwarakanath S, Deora H, Mehta S, Shukla D, A. A, Rao KVLN, Somanna S. Surgical Management of Large (≥3 cm) Trigeminal Schwannomas: Functional Outcomes and Approach Selection in Multicompartmental Schwannomas. J Neurol Surg B Skull Base 2024; 85:267-286. [PMID: 38721363 PMCID: PMC11076082 DOI: 10.1055/s-0043-1768443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 05/19/2024] Open
Abstract
Introduction Trigeminal schwannoma surgery has shown a remarkable improvement in functional recovery and tumor resection. In the era of radiosurgery, these outcomes need to be characterized for tumors which are outside the realm of being treated with radiosurgery. We present a series of trigeminal schwannomas larger than 3 cm, surgical approaches used, and outcomes with an emphasis on functional recovery in a high-volume center with radiosurgery facilities. Method All consecutive cases of trigeminal schwannoma from January 2012 to May 2021 which were more than 3 cm in size and underwent microsurgery were included in this series. The surgical approach, neurological outcomes, and extent of resection were defined objectively with pre/postoperative magnetic resonance imaging. Results A total of 83 such cases (>3 cm) were found, with cranial nerve symptoms (5th most common) being the commonest. Twenty three percent cases had blindness due to secondary optic atrophy and eighteen percent had long tract motor symptoms signifying the tumor burden in our series. Radiological gross total excision was achieved in 75.9% cases. Conclusion Large-volume schwannomas present with cranial nerve involvement and may need extensive skull base approaches. Functional outcomes need to be prioritized and can be achieved albeit with lesser gross resection rates. Hearing and facial preservation in addition to relief of trigeminal symptoms should be the goal of resection with minimal additional morbidity.
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Affiliation(s)
| | - Harsh Deora
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
| | - Sarthak Mehta
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
| | - Arivazhagan A.
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
| | - KVLN Rao
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
| | - Sampath Somanna
- Department of Neurosurgery, NIMHANS, Bangalore, Karnataka, India
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12
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Findlay MC, Bounajem MT, Mortimer V, Budohoski KP, Rennert RC, Couldwell WT. Preservation of cranial nerve function in large and giant trigeminal schwannoma resection: a case series. Acta Neurochir (Wien) 2024; 166:198. [PMID: 38684564 DOI: 10.1007/s00701-024-06094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/13/2024] [Indexed: 05/02/2024]
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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Affiliation(s)
- Matthew C Findlay
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Michael T Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Vance Mortimer
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Karol P Budohoski
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Robert C Rennert
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA.
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13
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Niranjan A, Faramand A, Raju SS, Lee CC, Yang HC, Nabeel AM, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Reda WA, Álvarez RM, Moreno NEM, Liscak R, May J, Mathieu D, Langlois AM, Snyder MH, Shepard MJ, Sheehan J, Muhsen BA, Borghei-Razavi H, Barnett G, Kondziolka D, Golfinos JG, Attuati L, Picozzi P, McInerney J, Daggubati LC, Warnick RE, Feliciano CE, Carro E, McCarthy D, Starke RM, Landy HJ, Cifarelli CP, Vargo JA, Flickinger J, Lunsford LD. Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study. Neurosurgery 2024; 94:165-173. [PMID: 37523519 DOI: 10.1227/neu.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei , Taiwan
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Cairo , Egypt
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Cairo , Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Cairo , Egypt
- Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo , Egypt
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Québec , Canada
| | - M Harrison Snyder
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Jason Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Baha'eddin A Muhsen
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Hamid Borghei-Razavi
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Gene Barnett
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Douglas Kondziolka
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - John G Golfinos
- Departments of Neurosurgery and Medical Physics, NYU Langone Health System, New York , New York , USA
| | - Luca Attuati
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - Piero Picozzi
- Department of Neurosurgery, Gamma Knife Humanitas Research Hospital, Milan , Italy
| | - James McInerney
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Lekhaj Chand Daggubati
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey , Pennsylvania , USA
| | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati , Ohio , USA
| | - Caleb E Feliciano
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - Eric Carro
- Department of Neurosurgery, Gamma Knife Center of Puerto Rico, San Juan , Puerto Rico
| | - David McCarthy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Robert M Starke
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Howard J Landy
- Department of Neurologic Surgery, University of Miami, Coral Gables , Florida , USA
| | - Christopher P Cifarelli
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John A Vargo
- Department of Neurologic Surgery, West Virginia University, Morgantown , West Virginia , USA
| | - John Flickinger
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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14
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Yin J, Wu Y, Zhang Z, Zhang Y, He J, Yang Z, Wang B, Wang X, Liu G, Bie Z, Liu P. Operative management of trigeminal schwannomas: based on a modified classification in a study of 93 cases. Acta Neurochir (Wien) 2023; 165:4157-4168. [PMID: 37999914 DOI: 10.1007/s00701-023-05857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Advances in microscopic and endoscopic surgical techniques have outpaced traditional classification and transcranial surgical strategies, especially with reference to the treatment of trigeminal schwannomas (TSs). A modified TS classification is proposed and appropriate surgical strategies are discussed. METHODS The cases of 93 patients who underwent surgical treatment in Beijing Tiantan Hospital in the previous 6 years were analyzed retrospectively, and a literature review was conducted. RESULTS Classification is based on surgical direction. Tumors were classified as follows: type A, backward orientation, located in the orbit or orbit and middle cranial fossa (8 cases, 8.6%); type B, upward orientation, located in the pterygopalatine fossa, infratemporal fossa or pterygopalatine fossa, infratemporal fossa, and middle cranial fossa (23 cases, 24.7%); type C, forward and backward orientations, located in the middle cranial fossa, posterior cranial fossa or both (58 cases, 62.4%); and type D, located in multiple regions (4 cases, 4.3%). 91.40% of patients underwent gross total resection (GTR) with 29 cases receiving endoscopic resection of whom 93.10% (27/29) experienced GTR. CONCLUSION The 93 cases were satisfactorily divided into four types, according to tumor location and surgical orientation, enabling safe and effective removal by appropriate surgery.
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Affiliation(s)
- Jie Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yihao Wu
- Department of Neurosurgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Zhe Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junhua He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xinchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Gemingtian Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhixu Bie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.
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15
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Luzzi S, Giotta Lucifero A, Baldoncini M, Nuñez M, Villalonga JF, Galzio R, Campero A. Comparative Analysis of Surgical Working Corridors for Meckel Cave Trigeminal Schwannomas: A Quantitative Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 25:e251-e266. [PMID: 37589470 DOI: 10.1227/ons.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Volumetric analysis of the working corridors of the interdural approach to the Meckel cave may lead to a selection of routes which are anatomically more advantageous for trigeminal schwannoma resection. The herein-reported anatomic study quantitively compares the infratrochlear (IT) transcavernous, anteromedial (AM), and anterolateral (AL) corridors, highlighting their feasibility, indications, advantages, and limitations. METHODS Anatomic boundaries and depth of Meckel cave, porus trigeminus, IT transcavernous, AM, and AL corridors were identified in 20 formalin-fixed latex-injected cadaveric heads and were subsequently measured. The corridor areas and volumes were derived accordingly. Each opening angle was also calculated. Angles and volumes were compared using analysis of variance. Statistical significance was set at a P -value <.05. RESULTS The IT transcavernous corridor volume was greater than that of the AM and AL. The opening angle of the AM middle fossa triangle was wider than the other 2. CONCLUSION The IT corridor can be advantageous for Meckel cave schwannomas invading the cavernous sinus and those with a notable extension into the posterior fossa because the transcavernous approach maximizes the working space into the retrosellar area. The AM middle fossa corridor is strategic in schwannomas confined to the Meckel cave with a minor extension into the posterior fossa. It raises the chance of total resection with a single approach involving the porus trigeminus opening.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matías Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Nuñez
- Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | - Juan F Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
| | - Renato Galzio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
- Hospital Padilla, Department of Neurological Surgery, Tucumán, Argentina
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16
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Wu X, Pan LS, Wu BW, Wu J, Chen YX, Xie SH, Wan XC, Din H, Zhan J, Xiao LM, Tang B, Hong T. Endoscopic Endonasal Approach for Trigeminal Schwannomas: Tailored Approaches Based on Lesion Traits. Laryngoscope 2023; 133:2564-2571. [PMID: 37341509 DOI: 10.1002/lary.30834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES To describe four endoscopic endonasal subapproaches, namely, the trans-lamina papyracea, trans-prelacrimal recess, trans-Meckel's cave, and transclival approaches for trigeminal schwannomas (TSs). METHODS This retrospective study reviewed the medical records and intraoperative videos of 38 patients with TSs who underwent endoscopic endonasal approach (EEA) between Jan 2013 and Dec 2021. RESULTS According to Jeong's classification, for TS equally in middle and posterior fossae (MP), a purely trans-Meckel's cave approach was carried out in 2 cases, and a combined transclival approach was carried out in 4 cases. The four tumors that involved infratemporal fossa (two E3, one mE3, and one Mpe3) were performed via a trans-prelacrimal recess approach, and type Mpe3 was also assisted by the trans-Meckel's cave approach. One patient with type E1 was treated with a trans-lamina papyracea approach. The other 27 cases, including type M, Mp, ME2, and MpE2, were all removed by a purely trans-Meckel's cave approach. Thirty-six patients (97.4%) received total resection under a purely EEA. The functional abilities and preoperative symptoms of 31 patients (88.6%) improved. Eight (21.1%) patients experienced permanent neurological function deficits. Postoperative cerebrospinal fluid and intraoperative internal carotid artery injury occurred in 1 (2.6%) patient. CONCLUSION According to the specific endoscopic endonasal subapproaches corresponding to the different TS locations, satisfactory results can be obtained for most types of tumors. It represents an effective alternative to the open transcranial approach and can also be properly used in most types of TS with experienced hands. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2564-2571, 2023.
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Affiliation(s)
- Xiao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lai Sheng Pan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bo Wen Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Xin Chen
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shen Hao Xie
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xi Chen Wan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Han Din
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Zhan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Min Xiao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Tang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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17
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Chen LP, Li D, Li XJ, Song LR, Zhang LW, Wu Z, Zhang JT, Wang L. Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve. Acta Neurochir (Wien) 2023; 165:2885-2893. [PMID: 37581723 DOI: 10.1007/s00701-023-05735-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
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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Affiliation(s)
- Liang-Peng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Xiao-Jie Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Lai-Rong Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- 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
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- 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 Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- 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.
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Chen P, Yan C, Xie T, Li C, Liu T, Yang Q, Liu S, Wu S, Yeh Y, Zhang X. Endoscopic far-lateral supracerebellar infratentorial approach for resection of dumbbell-shaped trigeminal schwannoma: surgical techniques and preliminary results. Acta Neurochir (Wien) 2023; 165:2913-2921. [PMID: 37523075 DOI: 10.1007/s00701-023-05725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Trigeminal schwannomas (TSs) are mostly benign tumors. However, dumbbell-shaped TSs are most challenging for surgeons and pose a high surgical risk. OBJECTIVE We describe the technique of the purely endoscopic far-lateral supracerebellar infratentorial approach (EFL-SCITA) for removing dumbbell-shaped TSs and further discuss the feasibility of this approach and our experience. METHODS EFL-SCITA was performed for resection of 5 TSs between January 2020 and March 2023. The entire procedure was performed endoscopically with the goal of total tumor resection. During the operation, the tumor was exposed in close proximity and multiple angles under the endoscope, and the peri-tumor nerves were carefully identified and protected, especially the normal trigeminal fiber bundles around the tumor. RESULTS All the tumors of 5 patients involved the middle and posterior cranial fossa, of which total removal was achieved in 2 patients and near-total removal in 3 patients. The most common preoperative symptoms were relieved after surgery. Two patients had postoperative mild facial paralysis (House-Brackmann grade II), and 1 patient had abducens palsy; both recovered during the follow-up period. Two patients experienced new postoperative facial hypesthesia, and 1 experienced mastication weakness, which did not recover. There was no tumor recurrence or residual tumor growth during the follow-up period in any of the patients. CONCLUSION EFL-SCITA is a new and effective alternative for the surgical treatment of TSs. For dumbbell-shaped TSs, this approach provides sufficient surgical field exposure and freedom of operation.
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Affiliation(s)
- Pin Chen
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chaolong Yan
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tengfei Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiaoqiao Yang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuang Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Silin Wu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyang Yeh
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
- Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China.
- Digital Medical Research Center, Fudan University, Shanghai, China.
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19
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Patel VA, Polster SP, Abou-Al-Shaar H, Kalmar CL, Zenonos GA, Wang EW, Gardner PA, Snyderman CH. Trigeminal Schwannoma: A Retrospective Analysis of Endoscopic Endonasal Management, Treatment Outcomes, and Neuropathic Sequelae. J Neurol Surg B Skull Base 2023; 84:444-451. [PMID: 37671297 PMCID: PMC10477009 DOI: 10.1055/s-0042-1755592] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/20/2022] [Indexed: 10/14/2022] Open
Abstract
Introduction Trigeminal schwannomas (TS) are rare skull base tumors that have been associated with significant neuropathic sequalae for patients. The authors aim to evaluate the clinical features, treatment outcomes, and neuropathic sequelae following endoscopic endonasal approach (EEA) for TS. Methods The study involves a retrospective review of patients who underwent EEA for resection of TS at a single academic institution between 2004 and 2020. Radiographic and clinical data were recorded and analyzed. Results A total of 16 patients were abstracted, with a mean age at the time of surgery of 44 years with a slight female (1.83:1) predominance. Primary preoperative symptomatology included facial pain/neuralgia ( n = 5, 31.3%), facial hypoesthesia ( n = 4, 25.0%), and headache ( n = 4, 25.0%). Following TS resection, patients were found to have facial hypoesthesia ( n = 11, 68.8%), neuropathic keratopathy ( n = 4, 25.0%), and mastication musculature atrophy ( n = 3, 18.8%). Patients with preoperative facial pain/neuralgia ( n = 5, 31.3%) were significantly more likely to try adjunctive pain therapies ( p = 0.018) as well as seek pain consultation ( p = 0.018). Patients with preoperative migraines ( n = 2, 12.5%) were significantly more likely to trial adjunctive pain therapies ( p = 0.025) and undergo evaluation with pain specialists ( p = 0.025). Finally, patients with preoperative pharmacologic agent utilization were significantly more likely to trial adjunctive pain therapies ( p = 0.036) and pursue pain consultation ( p = 0.036). Conclusion Some degree of trigeminal dysfunction may be more common than previously reported following EEA for TS resection. Factors that appear to play a role in the development of trigeminal dysfunction include pre-existing pain syndromes such as facial pain/neuralgia or headache and preoperative medication utilization.
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Affiliation(s)
- Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sean P. Polster
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Christopher L. Kalmar
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Georgios A. Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric W. Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul A. Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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20
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Manogaran RS, Arora K, Muraleedharan M, Kumar P, Aleesha M, Virk RS. Endonasal Endoscopic Trans-pterygoid Approach for Modified Jeffersons Type D V3 Schwannoma. Neurol India 2023; 71:888-892. [PMID: 37929422 DOI: 10.4103/0028-3886.388053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ravi Sankar Manogaran
- Neuro Otology Unit, Department of Neurosurgery, C-Block, SGPGIMS, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Kanika Arora
- Neuro Otology Unit, Department of Neurosurgery, C-Block, SGPGIMS, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Manjul Muraleedharan
- Neuro Otology Unit, Department of Neurosurgery, C-Block, SGPGIMS, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Prince Kumar
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Aleesha
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh Virk
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Wu EM, Sun MZ, Khan NR, Benjamin CG, Morcos JJ. Combined Transcavernous and Anterior Petrosectomy [Kawase] Approach to a Trigeminal Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e150. [PMID: 37306965 DOI: 10.1227/ons.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/13/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Eva M Wu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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22
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Karras CL, Texakalidis P, Thirunavu VM, Nandoliya KR, Khazanchi R, Byrne K, Chandler JP, Magill ST. Outcomes following surgical resection of trigeminal schwannomas: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:215. [PMID: 37646878 DOI: 10.1007/s10143-023-02121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Although typically benign, trigeminal schwannomas (TS) may require surgical resection when large or symptomatic and can cause significant morbidity. This study aims to summarize the literature and synthesize outcomes following surgical resection of TS. A systematic review was performed according to PRISMA guidelines. Data extracted included patient and tumor characteristics, surgical approaches, and postoperative outcomes. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were used for outcome analysis. The initial search yielded 1838 results, of which 26 studies with 974 patients undergoing surgical resection of TS were included. The mean age was 42.9 years and 58.0% were female. The mean tumor diameter was 4.7 cm, with Samii type A, B, C, and D tumors corresponding to 33.4%, 15.8%, 37.2%, and 13.6%, respectively. Over a mean symptom duration of 29 months, patients presented with trigeminal hypesthesia (58.7%), headache (32.8%), trigeminal motor weakness (22.8%), facial pain (21.3%), ataxia (19.4%), diplopia (18.7%), and visual impairment (12.0%). Surgical approaches included supratentorial (61.4%), infratentorial (15.0%), endoscopic (8.6%), combined/staged (5.3%), and anterior (5.7%) or posterior (4.0%) petrosectomy. Postoperative improvement of facial pain (83.9%) was significantly greater than trigeminal motor weakness (33.0%) or hypesthesia (29.4%). The extent of resection (EOR) was reported as gross total (GTR), near total, and subtotal in 77.7%, 7.7%, and 14.6% of cases, respectively. Over a mean follow-up time of 62.6 months, recurrence/progression was noted in 7.4% of patients at a mean time to recurrence of 44.9 months. Patients with GTR had statistically significantly lower odds of recurrence/progression (OR: 0.07; 95% CI: 0.04-0.15) compared to patients with non-GTR. This systematic review and meta-analysis report patient outcomes following surgical resection of TS. EOR was found to be an important predictor of the risk of recurrence. Facial pain was more likely to improve postoperatively than facial hypesthesia. This work reports baseline rates of post-operative complications across studies, establishing benchmarks for neurosurgeons innovating and working to improve surgical outcomes for TS patients.
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Affiliation(s)
| | - Pavlos Texakalidis
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | | | | | - Rushmin Khazanchi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kayla Byrne
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
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23
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Adachi K, Hasegawa M, Hirose Y. Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study. Neurosurg Rev 2023; 46:137. [PMID: 37286772 DOI: 10.1007/s10143-023-02045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/06/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
The efficacy of spinal drain (SD) placement for cerebrospinal fluid (CSF) leakage prevention after the anterior transpetrosal approach (ATPA) remains unclear. Thus, we aimed to assess whether postoperative SD placement improved postoperative CSF leakage after a skull base reconstruction procedure using a small abdominal fat and pericranial flap and clarify whether bed rest with postoperative SD placement increased the length of hospital stay. This retrospective cohort study included 48 patients who underwent primary surgery using ATPA between August 2011 and February 2022. All cases underwent SD placement preoperatively. First, we evaluated the necessity of SD placement for CSF leakage prevention by comparing the postoperative routine continuous SD placement period to a period in which the SD was removed immediately after surgery. Second, the effects of different SD placement durations were evaluated to understand the adverse effects of SD placement requiring bed rest. No patient with or without postoperative continuous SD placement developed CSF leakage. The median postoperative time to first ambulation was 3 days shorter (P < 0.05), and the length of hospital stay was 7 days shorter (P < 0.05) for patients who underwent SD removal immediately after surgery (2 and 12 days, respectively) than for those who underwent SD removal on postoperative day 1 (5 and 19 days, respectively). This skull base reconstruction technique was effective in preventing CSF leakage in patients undergoing ATPA, and postoperative SD placement was not necessary. Removing the SD immediately after surgery can lead to earlier postoperative ambulation and shorter hospital stay by reducing medical complications and improving functional capacity.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan.
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan
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24
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Kong DS, Kim YH, Lee WJ, Kim YH, Hong CK. Indications and outcomes of endoscopic transorbital surgery for trigeminal schwannoma based on tumor classification: a multicenter study with 50 cases. J Neurosurg 2023; 138:1653-1661. [PMID: 36681991 DOI: 10.3171/2022.9.jns22779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Trigeminal schwannoma is a rare CNS tumor and involves the multicompartmental skull base. Recently, the endoscopic transorbital approach (ETOA) has emerged as a technique for minimally invasive surgery. The objective of this study was to evaluate the optimal indications and clinical outcomes of the ETOA for trigeminal schwannomas based on their tumor classification. METHODS Between September 2016 and February 2022, the ETOA was performed in 50 patients with trigeminal schwannoma at four tertiary hospitals. There were 15 men and 35 women in the study, with a mean age of 46.9 years. All tumors were classified as type A (predominantly involving the middle cranial fossa), type B (predominantly involving the posterior cranial fossa), type C (dumbbell-shaped tumors involving the middle and posterior fossa), or type D (involvement of the extracranial compartment). Type D tumors were also subclassified by ophthalmic division (D1), maxillary division (D2), and mandibular division (D3). Clinical outcome was analyzed, including extent of resection and surgical morbidities. RESULTS In this study, overall gross-total resection (GTR) was performed in 35 (70.0%) of 50 patients and near-total resection (NTR) in 9 patients (18.0%). The mean follow-up period was 21.9 (range 1-61.7) months. There was no tumor regrowth or recurrence during the follow-up period. Based on the classification, there were 17 type A tumors, 20 type C, and 13 type D. There were no type B tumors. Of the 13 type D tumors, 7 were D1, 1 D2, and 5 D3. For type A tumors, GTR or NTR was achieved using an ETOA in 16 (94.1%) of 17 patients. Eighteen (90.0%) of 20 patients with type C tumors attained GTR or NTR. Ten (76.9%) of 13 patients with type D tumors underwent GTR. Statistical analysis showed that there was no significant difference in the extent of resection among the tumor subtypes. Surgical complications included transient partial ptosis (n = 4), permanent ptosis (n = 1), transient diplopia (n = 7), permanent diplopia (n = 1), corneal keratopathy (n = 7), difficulties in mastication (n = 5), and neuralgic pain or paresthesia (n = 14). There were no postoperative CSF leaks or enophthalmos during follow-up. CONCLUSIONS This study showed that trigeminal schwannomas can be effectively treated with a minimally invasive ETOA in all tumor types, except those predominantly involving the posterior fossa (type B). For the extracranial compartments, D2 or D3 tumor types often require an ETOA combined with the endoscopic endonasal approach, while D1 tumor types can be treated using an ETOA alone.
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Affiliation(s)
- Doo-Sik Kong
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University
| | - Yong Hwy Kim
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University; and
| | - Won-Jae Lee
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University
| | - Young-Hoon Kim
- 3Department of Neurosurgery, Asan Medical Center, Ulsan University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Ki Hong
- 3Department of Neurosurgery, Asan Medical Center, Ulsan University of Ulsan College of Medicine, Seoul, Korea
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25
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Dandekar AC, Mehta NA. A Case of Malignant Melanotic Schwannoma of the Trigeminal Nerve: A Case Report and Review of Literature. Asian J Neurosurg 2023; 18:352-356. [PMID: 37397058 PMCID: PMC10313432 DOI: 10.1055/s-0043-1768578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Intracranial melanotic schwannoma is quite rare, and involvement of the trigeminal nerve is even rarer. Early diagnosis and surgical excision are the mainstays of management. These tumors have a high tendency to recur and there is high possibility of metastasis. Adjuvant radiotherapy should be considered since the prognosis is uncertain. A 23-year-old man started developing numbness over the left side of the forehead 9 months ago that progressed to involve the ipsilateral cheek. The patient started having diplopia on looking to the left side 8 months ago. His relatives noticed a change in his voice 1 month ago and he developed weakness in the right upper and lower limbs, which was gradually progressive. The patient had slight difficulty swallowing. After examination, we found involvement of multiple cranial nerves with pyramidal signs. Magnetic resonance imaging (MRI) was suggestive of an extra-axial lesion in the left cerebellopontine angle extending into the middle cranial fossa, which was having high T1 and T2 signal loss with contrast enhancement. We achieved near-total excision of the tumor via a subtemporal extradural approach. Trigeminal melanotic schwannoma is a rare occurrence constituting melanin-producing cells and Schwann cells. Rapid progression of symptoms and signs should prompt the suspicion of the possible malignant nature of the pathology. Extradural skull base approaches reduce the risk of postoperative deficits. Differentiating melanotic schwannoma from malignant melanoma is of utmost importance in planning of management.
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Affiliation(s)
| | - Nirav A. Mehta
- Department of Neurosurgery, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India
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26
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Li X, Han S, Sun X, Bai Y, Zhang Q, Feng S, Liang G. Hybrid endoscopic-microscopic surgery for dumbbell-shaped trigeminal schwannoma: case report and literature review. Front Oncol 2023; 13:1137711. [PMID: 37274266 PMCID: PMC10235621 DOI: 10.3389/fonc.2023.1137711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023] Open
Abstract
Background The surgery of dumbbell-shaped trigeminal neurinomas (TN) remains one of the most formidable challenges for neurosurgeons because of its location at great depth in the cranium and proximity to vital neurovascular structures. Objective To describe the feasibility of a novel technique, synchronous endoscopy and microsurgery via combined far-lateral supracerebellar-infratentorial and subtemporal approach, for resection of this rare entity. Methods A 53-year-old women presented with progressive left facial numbness for 2 months. Imaging examinations revealed a left-sided dumbbell-shaped TN afflicting the middle and posterior cranial fossa, and a single-stage combined multiportal endoscopic microscopic approach was attempted for tumor resection. Initially, a purely endoscopic far-lateral supracerebellar-infratentorial approach was used to remove the posterior fossa component with the aid of tentorium incision. Subsequently, a microsurgical subtemporal interdural approach was performed for the exposure and separation of tumor within the Meckel cave. Finally, the tumor was pushed into the porus trigeminus under microscopy, thus enabling tumor extraction for the supracerebellar space under endoscopy without anterior petrosectomy. Results The patient evolved favorably without additional neurological deficit after surgery, and postoperative imaging showed a complete resection of the tumor. Conclusion We describe the first account of multi-corridor hybrid surgery for removal of TN in a dumbbell configuration, which enables one-stage total tumor removal with minimal added morbidity. This hybrid technique may be an effective piece of the surgeon's armamentarium to improve outcomes of patient with complex skull-base lesions. Further studies with larger case numbers are warranted to confirm the prognostic significance of this technique.
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Affiliation(s)
| | | | | | | | | | - Sizhe Feng
- *Correspondence: Sizhe Feng, ; Guobiao Liang,
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27
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Shibao S, Yoshida K. Simplified anterior transpetrosal approach without superior petrosal sinus and tentorial incision for lesions centered in Meckel's cave. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05584-9. [PMID: 37099067 DOI: 10.1007/s00701-023-05584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/08/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The anterior transpetrosal approach (ATPA) is an effective method to reach lesions in the petroclival region. This approach involves many steps, including superior petrosal sinus (SPS) ligation and tentorial cutting. It is sometimes unnecessary to perform all procedures in the ATPA for certain lesions, especially those centered in the Meckel's cave. Here, we present a simplified anterior transpetrosal approach (SATPA) without superior petrosal sinus and tentorial incision for lesions centered in the Meckel's cave as a modified ATPA. METHODS This study included 13 patients treated with SATPA. The initial steps of SATPA are similar to ATPA, excluding a middle cranial fossa dural incision, SPS dissection, or tentorial incision. Histological examination was performed to understand the membrane structure of the trigeminal nerve, which runs through the Meckel's cave. RESULTS Pathology revealed trigeminal schwannoma (n=11), extraventricular central neurocytoma (n=1), and a metastatic tumor (n=1). The average tumor size was 2.4 cm. The total removal rate was 76.9% (10/13). Permanent complications included trigeminal neuropathy in four cases and cerebrospinal fluid leakage in one case. Histological examination revealed the trigeminal nerve traverses the subarachnoid space from the posterior fossa subdural space to the Meckel's cave and is covered with the epineurium in the inner reticular layer. CONCLUSIONS We used SATPA for lesions located in the Meckel's cave identified using histological examination. This approach may be considered for small- to medium-sized lesions centered in the Meckel space. CLINICAL TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- Shunsuke Shibao
- Department of Neurosurgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Poorna T A, Jr L, Ek J, John B, S N, S S. Extracranial schwannoma of the maxillary nerve misdiagnosed as trigeminal neuralgia in an elderly patient with schizophrenia - A diagnostic dilemma. SPECIAL CARE IN DENTISTRY 2023; 43:276-280. [PMID: 35916362 DOI: 10.1111/scd.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
The present paper discusses the diagnostic challenges we faced in a 60-year-old woman with a history of schizophrenia, presenting with left unilateral facial pain for the past three months. Based on the elaborate clinical examination and diagnostic nerve blocks, the patient was diagnosed with trigeminal neuralgia (TN) and non-surgical therapy commenced. Further investigations with magnetic resonance imaging (MRI) and ultrasound-guided fine needle aspiration cytology (FNAC) revealed the presence of an extracranial schwannoma involving a branch of the maxillary nerve. The patient was symptomatically relieved after surgical excision of the benign tumor under general anesthesia. Hence, we emphasize the need for special care and attention in psychiatric patients presenting with orofacial pain.
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Affiliation(s)
| | - Lokesh Jr
- Government Dental College, Kottayam, Kerala, India
| | - Joshna Ek
- Government Dental College, Kottayam, Kerala, India
| | - Bobby John
- Government Dental College, Kottayam, Kerala, India
| | - Neethu S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
| | - Shankar S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
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Shapira Y, Juniat V, Dave T, Hussain A, McNeely D, Watanabe A, Yoneda A, Saeed P, Woo KI, Hardy TG, Price B, Drummond K, Selva D. Orbito-cranial schwannoma-a multicentre experience. Eye (Lond) 2023; 37:48-53. [PMID: 34999720 PMCID: PMC9829917 DOI: 10.1038/s41433-021-01850-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/10/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the features, management approaches, and outcomes of orbito-cranial schwannomas. METHODS Retrospective review of ten patients with orbito-cranial schwannomas managed in six orbital services over 22 years. Data collected included demographics, presenting features, neuroimaging characteristics, histology, management approach, complications, and outcomes. RESULTS Mean age of the patients was 41.4 ± 19.9 years, and 6 (60%) were females. The majority presented with proptosis (90%), limited extraocular motility (80%), eyelid swelling (60%), and optic neuropathy (60%). Most lesions (80%) involved the entire anterior-posterior span of the orbit, with both intra- and extraconal involvement. All tumours involved the orbital apex, the superior orbital fissure, and extended at least to the cavernous sinus. Surgical resection was performed for all. Seven (70%) of the tumours were completely or subtotally resected combining an intracapsular approach by an orbital-neurosurgical collaboration, with no recurrence on postoperative follow-up (6-186 months). Three underwent tumour debulking. Of these, two remained stable on follow-up (6-34 months) and one showed progression of the residual tumour over 9 years (cellular schwannoma on histology) necessitating stereotactic radiotherapy (SRT) for local control. Adjuncts to the orbito-cranial resection included perioperative frozen section (n = 5), endoscopic transorbital approach (n = 2), and image-guided navigation (n = 1). Post-surgical adjuvant SRT was used in three subjects. CONCLUSIONS These results highlight the possibility of successful surgical control in complex orbito-cranial schwannomas. A combined neurosurgical/orbital approach with consideration of an intracapsular resection is recommended. Recurrence may not occur with subtotal excision and observation may be reasonable. Adjunctive SRT for progression or residual tumour can be considered.
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Affiliation(s)
- Yinon Shapira
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia.
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia.
| | - Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia
| | - Tarjani Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Ahsen Hussain
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Daniel McNeely
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akiko Yoneda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Peerooz Saeed
- Departments of Ophthalmology, Orbital Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Benjamin Price
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kate Drummond
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia
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Bezborodova TY, Zolotova SV. [Trigeminal neuromas: modern diagnosis and treatment]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:104-110. [PMID: 36763561 DOI: 10.17116/neiro202387011104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Trigeminal neuroma (TN) is a benign neoplasm arising from trigeminal nerve sheath. The tumor can grow from any part of the nerve from the root in posterior cranial fossa to peripheral extracranial branches. Symptoms of trigeminal neuroma are variable and usually depend on location and dimensions of tumor. We present a review devoted to the problem of TN. Surgery was the only possible option in patients with TN for a long time. However, radiotherapy became one of the options and sometimes alternative to surgical treatment since the late 1980s. Besides active management of patients with TN, follow-up with regular radiographic control of small asymptomatic tumors also seems to be reasonable. When evaluating treatment outcomes, physicians consider quality of life and return to previous work and activity in addition to resection quality, neurological impairment, relapse-free period and tumor growth control. However, assessment of these indicators after certain treatment is rare. Thus, it is difficult to determine treatment strategy with maximum ratio of effectiveness and quality of life. Therefore, optimization of TN treatment is currently an urgent problem that requires further study.
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Matsushima K, Kohno M. Trigeminal Schwannoma Surgery: Challenges in Preserving Facial Sensation. Adv Tech Stand Neurosurg 2023; 46:95-107. [PMID: 37318571 DOI: 10.1007/978-3-031-28202-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Treatments of schwannoma have dramatically improved in the previous few decades, but preservation of the functions of the originating nerve, such as facial sensation in trigeminal schwannomas, still remains challenging. As the preservation of facial sensation in trigeminal schwannomas has not been analyzed in detail, we here review our surgical experience of more than 50 trigeminal schwannoma patients, particularly focusing on their facial sensation. Since the facial sensation in each trigeminal division showed a different perioperative course even in a single patient, we investigated patient-based outcomes (average of the three divisions in each patient) and division-based outcomes separately. In the evaluation of patient-based outcomes, facial sensation remained postoperatively in 96% of all the patients, and improved in 26% and worsened in 42% of patients with preoperative hypesthesia. Posterior fossa tumors tended to most rarely disrupt facial sensation preoperatively, but were the most difficult to preserve facial sensation postoperatively. Facial pain was relieved in all six patients with preoperative neuralgia. In the division-based evaluation, facial sensation remained postoperatively in 83% of all the trigeminal divisions, and improved in 41% and worsened in 24% of the divisions with preoperative hypesthesia. The V3 region was most favorable before and after surgery, with the most frequent improvement and the least frequent functional loss. To clarify current treatment outcomes of the facial sensation and to achieve more effective preservation, standardized assessment methods of perioperative facial sensation may be required. We also introduce detailed MRI investigation methods for schwannoma, including contrast-enhanced heavily T2-weighted (CISS) imaging, arterial spin labeling (ASL), and susceptibility-weighted imaging (SWI), preoperative embolization for rare vascular-rich tumors, and modified techniques of the transpetrosal approach.
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Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
- Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
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Adachi K, Hasegawa M, Hirose Y. Epidural and subdural interdural approach to the lateral wall of the cavernous sinus for preserving the laterocavernous sinus in trigeminal schwannoma. Neurosurg Rev 2022; 46:27. [PMID: 36576615 DOI: 10.1007/s10143-022-01934-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/22/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Evacuation of middle fossa trigeminal schwannomas (TS) warrants a subtemporal interdural approach through the lateral wall of the cavernous sinus (CS). The dura comprises the dura propria, which follows the trigeminal nerve and develops into the epineurium, and periosteal layer. The interdural approach involves peeling off the dura propria and exposing the epineural sheath. The venous route around the CS is often obstructed due to TS progression. The interdural approach based on venous route preservation remains to be discussed. The laterocavernous sinus (LCS) is formed in these layers, draining to either the medial or lateral route. In the lateral route, the LCS drains to the pterygoid plexus via the middle cranial fossa foramen. Exposure of the interdural space disturbs the lateral route's venous flow. We describe an operative strategy for venous route preservation in TS via the LCS lateral route. The venous route can be preserved by peeling off the dura propria from the posterior end of the foramen ovale short of the venous drainage route to the pterygoid plexus epidurally and then cutting from the middle cranial fossa dura posterior to the venous route subdurally to the exposed interdural space. This technique helps in avoiding postoperative venous complications.
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Affiliation(s)
- Kazuhide Adachi
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan.
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi, 470-1192, Japan
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Aftahy AK, Groll M, Wagner A, Barz M, Bernhardt D, Combs SE, Meyer B, Gempt J, Negwer C. Schwannomas of the greater superficial petrosal nerve - case series, discussion of surgical techniques, and review of literature. BMC Neurol 2022; 22:470. [PMID: 36494617 PMCID: PMC9733176 DOI: 10.1186/s12883-022-02960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas account for about 0.8% of all petrous mass lesions. Schwannomas of the greater superficial petrosal nerve (GSPN) are a rare subtype with few case-reports up to date. CASE PRESENTATIONS A retrospective analysis of clinical outcomes, radiographic findings and postoperative complication between June 2007 and December 2020 was performed. Four cases of GSPN schwannomas were reported. The presenting symptoms were facial nerve palsy and hearing loss. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone, in one case with extraordinary petrous bone and mastoid infiltration and destruction. Three cases were removed through a subtemporal extra- or intradural approach, one case via a combined pre- and retrosigmoid approach. Improvement of facial nerve palsy occurred in one case; new hearing loss was observed in another case. Xeropthalmia was a short-term temporary deficit in three cases. Short- to mid-term follow-up of the patients has not shown any tumor recurrence. CONCLUSIONS GSPN schwannomas are rare entities presenting with heterogenous symptoms. Our surgical findings emphasize safe resection. Complete remission is possible by GTR. Since the small data set limits the expressiveness of statements regarding standard of care and alternative therapy options, additional data is needed.
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Affiliation(s)
- A. Kaywan Aftahy
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Maximilian Groll
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Arthur Wagner
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Melanie Barz
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Denise Bernhardt
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Radio-Oncology, Technical University Munich, Munich, Germany
| | - Stephanie E. Combs
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Radio-Oncology, Technical University Munich, Munich, Germany
| | - Bernhard Meyer
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Jens Gempt
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Chiara Negwer
- grid.6936.a0000000123222966School of Medicine, Klinikum Rechts Der Isar, Department of Neurosurgery, Technical University Munich, Munich, Germany
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2022; 83:561-578. [PMID: 36393883 PMCID: PMC9653294 DOI: 10.1055/a-1934-9191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/17/2023] Open
Abstract
Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
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Purely Endonasal Endoscopic Approaches for Extracranial Trigeminal Nerve Schwannoma. J Craniofac Surg 2022; 33:2473-2476. [PMID: 35765130 DOI: 10.1097/scs.0000000000008687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the effectiveness and safety of purely endonasal endoscopic resection of extracranial trigeminal schwannomas (TGSs), with assessment of surgical and clinical outcomes in order to identify optimal candidates for an endonasal endoscopic approach (EEA). METHODS A retrospective review of patient's records operated for TGSs between 2008 and 2021 was conducted. Patients operated with a purely EEA were included in this study. Pictures from a frozen fresh cadaver head dissection were used to demonstrate the surgical approach and to show anatomic relationships, complexity of the surgical area and safe corridors for surgery. RESULTS A total of 5 patients (4 females and 1 male) were operated for TGS. All patients had facial numbness (100%) as a presenting symptom, followed by facial pain in 2 patients (40%), and orbital pain in 1 (20%). Also, 3 patients (60%) had a tumor originating at the level of the foramen ovale and 2 (40%) at the foramen rotundum. The mean tumor diameter was 3,7 ± 2 cm. Gross total resection were achieved in all cases. Postoperatively, 1 patient had severe mastication problems, 1 had blurred vision, and in the long-term follow-up, 1 had frontal sinusitis. The mean follow up was 106.6 (min:49, max:132, SD: 29.82) months. No recurrences were detected. CONCLUSIONS In cases with the extradural TGS having limited extension into Posterior Cranial Fossa, or located in the Middle Cranial Fossa, a purely EEA is possible even for tumors bigger in size. Unilateral endonasal corridors are adequate for resection in most cases.
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII). Acta Neurochir (Wien) 2022; 164:299-319. [PMID: 35079891 DOI: 10.1007/s00701-021-05092-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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Thaduri A, Kottayasamy Seenivasagam R, Majumdar KS, Usmani SA, Maharaj DD, Panuganti A. Trans-cervical mandibulotomy approach for a multi-compartmental trigeminal Schwannoma: A surgeon's guide. Oral Oncol 2021; 122:105572. [PMID: 34662772 DOI: 10.1016/j.oraloncology.2021.105572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
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Petrous bone lesions: surgical implementation and outcomes of extradural subtemporal approach. Acta Neurochir (Wien) 2021; 163:2881-2894. [PMID: 34420107 DOI: 10.1007/s00701-021-04962-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Petrous bone lesions (PBLs) are rare with few reports in the neurosurgical literature. In this study, the authors describe our current technique of extradural subtemporal approach (ESTA). The objective of this study was to evaluate the role and efficacy of ESTA for treatment of the PBLs. To our knowledge, this is the largest reported clinical series of using an ESTA-treated PBLs in which the clinical outcomes were evaluated. METHODS Between 1994 and 2019, 67 patients with PBLs treated by ESTA were retrospectively reviewed. Extent of resection, neurological outcomes, recurrence rate, and surgical complications were evaluated and compared with previous studies. The indications, advantages, limitations, and outcomes of ESTA were analyzed according to pathology. RESULTS This series included 7 facial nerve schwannomas (10.4%), 16 cholesterol granulomas (23.9%), 16 chordomas (23.9%), 6 chondrosarcomas (9%), 5 trigeminal schwannomas (7.5%), 9 epidermoids/dermoids (13.4%), and 8 other pathologies (11.9%). The most common location of PBLs operated with ESTA was at the petrous apex and rhomboid areas (68.7%). Gross total resection was achieved in 35 (55.6%). Symptomatic improvement occurred in 56 patients (83.6%). Complications occurred in 7 (10.4%) of cases including one mortality. Nine patients (17%) had recurrence within the mean follow-up 71 months. Compared to previous literature, our results demonstrated comparable outcomes but with higher rates of hearing and facial nerve preservation as well as minimal morbidity. From our results, ESTA is an effective therapeutic option for lesions located at the rhomboid and petrous apex, particularly when patients presented with intact facial and hearing function. CONCLUSION Our series demonstrated that ESTA provided satisfactory outcomes with excellent benefits of hearing and facial function preservation for patients with petrous bone lesions. ESTA should be considered as a safe and effective therapeutic option for selected patients with PBLs.
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Bawornvaraporn U, Zomorodi AR, Friedman AH, Fukushima T. Neurosurgical management of petrous bone lesions: classification system and selection of surgical approaches. Acta Neurochir (Wien) 2021; 163:2895-2907. [PMID: 34313854 DOI: 10.1007/s00701-021-04934-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgery of petrous bone lesions (PBLs) is challenging for neurosurgeons. Selection of the surgical approach is an important key for success. In this study, the authors present an anatomical classification for PBLs that has been used by our group for over the past 26 years. The objective of this study is to investigate the benefits and applicability of this classification. METHODS Between 1994 and 2019, 117 patients treated for PBLs were retrospectively reviewed. Using the V3 and arcuate eminence as reference points, the petrous bone is segmented into 3 parts: petrous apex, rhomboid, and posterior. The pathological diagnoses, selection of the operative approach, and the extent of resection (EOR) were analyzed and correlated using this classification. RESULTS This series included 22 facial nerve schwannomas (18.8%), 22 cholesterol granulomas (18.8%), 39 chordomas/chondrosarcomas (33.3%), 6 trigeminal schwannomas (5.1%), 13 epidermoids/dermoids (11.1%), and 15 other pathologies (12.8%). PBLs were most often involved with the petrous apex and rhomboid areas (46.2%). The extradural subtemporal approach (ESTA) was most frequently used (57.3%). Gross total resection was achieved in 58.4%. Symptomatic improvement occurred in 92 patients (78.6%). Our results demonstrated a correlation between this classification with each type of pathology (p < .001), selection of surgical approaches (p < 0.001), and EOR (p = 0.008). Chordoma/chondrosarcoma, redo operations, and lesions located medially were less likely to have total resection. Temporary complications occurred in 8 cases (6.8%), persistent morbidity in 5 cases (4.3%), and mortality in 1 case. CONCLUSION In this study, we proposed a simple classification of PBLs. Using landmarks on the superior petrosal surface, the petrous bone is divided into 3 parts, apex, rhomboid, and posterior. Our results demonstrated that chordoma/chondrosarcoma, redo operations, and lesions involving the tip of the petrous apex or far medial locations were more difficult to achieve total resection. This classification could help surgeons understand surgical anatomy framework, predict possible structures at risk, and select the most appropriate approach for each patient.
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Affiliation(s)
- Udom Bawornvaraporn
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
| | - Ali R Zomorodi
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Allan H Friedman
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Niranjan A, Raju SS, Kano H, Flickinger JC, Lunsford LD. Clinical and Imaging Response to Trigeminal Schwannoma Radiosurgery: A Retrospective Analysis of a 28-Year Experience. J Neurol Surg B Skull Base 2021; 82:491-499. [PMID: 34513554 DOI: 10.1055/s-0040-1714110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate long-term clinical outcomes and tumor control after stereotactic radiosurgery (SRS) for trigeminal schwannoma (TS). Methods During a 28-year period (1989-2017), 50 patients underwent SRS for TS. The median patient age was 51 years (range: 15-87 years). A total of 17 patients had a previous tumor resection: 10 had a single procedure, 5 had two procedures, and 2 had three procedures. The median and mean times between tumor resection and SRS were 12 and 24 months (range: 1-90 months), respectively. Four patients had neurofibromatosis II (NF2). Based on location, tumors were classified as root type (7), ganglion type (22), or dumbbell type (21). The median radiosurgery target volume was 3.4 cm 3 (range: 0.10-18 cm 3 ), median target dose was 14 Gy (range: 12-20 Gy), and the median number of isocenters was 6 (range: 1-15). The median and mean times to last follow-up was 36.9 and 55.2 months (range: 4-205 months), respectively. Eighteen patients (36%) had longer than 5-year follow-up, and seven patients (14%) had longer than 10-year follow-up. Results The tumor control rate was 92% and the clinical improvement or stabilization rate was 94%. After SRS, the rates of progression free survival (PFS) at 1, 5, and 10 years were 98, 84, and 84%, respectively. Factors associated with improved PFS were female sex ( p = 0.014) and smaller tumor volume ( p = 0.022). In this series, we did not find that tumor type (root, ganglion, and dumbbell) had a statistically significant correlation to PFS. Forty-seven patients had neurological signs or symptoms at presentation. At last follow-up, neurological signs or symptoms improved in 22/47 (47%), remained unchanged in 24/50 (48%), and worsened due to tumor progression in 3/50 (6%). One patient (2%) developed temporary symptomatic adverse radiation effect (ARE) and three additional patients (6%) had transient imaging evidence of peritumoral reactive edema but no new symptoms. Conclusion As a single outpatient procedure, SRS was associated with long-term freedom from additional management in 84% of patients. Nearly half the treated patients experienced improvement in neurological symptoms or signs.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Lawrence Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Tomio R, Horiguchi T, Borghei-Razavi H, Tamura R, Yoshida K, Kawase T. Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications. J Neurosurg 2021; 136:413-421. [PMID: 34388716 DOI: 10.3171/2020.12.jns204010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anterior transpetrosal approach (ATPA) was initially reported in 1985. The authors' institution has 274 case records of surgery performed with the ATPA during the period from 1984 to 2017. Although many technical advances and modifications in the ATPA have occurred over those 33 years, to the authors' knowledge no articles to date have reported a detailed analysis of variations and complications of the ATPA. In this study, the authors analyzed their patient series to elucidate improvements over time in ATPA methodology while highlighting unresolved problems and evaluating how to avoid surgical complications. METHODS All surgical cases (274 patients) using the ATPA at the authors' institution during the period from 1984 to 2017 were analyzed retrospectively using charts, clinical summaries, operative records, and operative videos. Obtained parameters were patient age and sex, diagnosis, size of tumors, location of disease, operative date, neurological symptoms before and after surgery, radiographically identified brain injury, and other surgical complications. The most common diagnosis was petroclival meningioma (n = 158), followed by trigeminal schwannoma (n = 32), chordoma (n = 25), epidermoid tumor (n = 21), other tumor (n = 27), aneurysm (n = 6), and other (n = 5). RESULTS The original ATPA was performed in 239 cases. In an additional 35 cases, a modified ATPA was performed. Zygomatic osteotomy with ATPA was a common modification that was used in 19 of the 35 cases to decrease retraction damage to the temporal lobe for high-positioned tumors. Brain injury by temporal lobe retraction without venous hemorrhage still occurred in 8 of the 19 cases (3.1%) with surgical death in 1 of these cases (0.4%) of reoperation with sacrifice of the petrosal vein. Symptomatic CSF leak was the most frequent complication noted and was observed in 35 cases (13.5%). In most of these cases the patients were cured by observation or lumbar drain, but in 6 cases (17.1%) reoperation was needed. Facial nerve damage related to surgical approach decreased from 6.2% to 3.5% after 2010; however, the incidence of CSF leaks (13.5%) has not improved. CONCLUSIONS There have been several modifications and advancements made in the ATPA to increase tumor removal and decrease surgical complications. However, complications related to surgical approach occurred, such as venous occlusion-related brain injury and facial nerve damage at pyramid resection. CSF leak remained an unsolved problem related to the ATPA procedures. Preoperative assessment of venous variation of the middle fossa, pneumatization of the temporal bone, and intraoperative monitoring of cranial nerves are important procedures to decrease these complications.
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Affiliation(s)
- Ryosuke Tomio
- 1Department of Neurology and Brain Bank, Mihara Memorial Hospital, Gunma, Japan
| | - Takashi Horiguchi
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Hamid Borghei-Razavi
- 3Department of Neurosurgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida
| | - Ryota Tamura
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Kazunari Yoshida
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
| | - Takeshi Kawase
- 2Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan; and
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Landry AP, Ye VC, Vaughan KA, Drake JM, Dirks PB, Cusimano MD. Pediatric multicompartmental trigeminal schwannoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2171. [PMID: 35855022 PMCID: PMC9245852 DOI: 10.3171/case2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.
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Affiliation(s)
| | - Vincent C. Ye
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Kerry A. Vaughan
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - James M. Drake
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Peter B. Dirks
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Michael D. Cusimano
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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Oyama K, Watanabe K, Hanakita S, Champagne PO, Passeri T, Voormolen EH, Bernat AL, Penet N, Fukushima T, Froelich S. The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus. J Neurosurg 2021; 134:1480-1489. [PMID: 32534497 DOI: 10.3171/2020.3.jns2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity. METHODS Five formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article. RESULTS Via the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2). CONCLUSIONS Opening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.
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Affiliation(s)
- Kenichi Oyama
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Kentaro Watanabe
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Shunya Hanakita
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Pierre-Olivier Champagne
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Thibault Passeri
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Eduard H Voormolen
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Anne Laure Bernat
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Nicolas Penet
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
| | - Takanori Fukushima
- 2Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Sébastien Froelich
- 1Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France, and
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Lin Y, Gao Q, Jin H, Wang N, Xu D, Wang F, Guo AB, Zang W, Li Z, Guo F. Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center. Front Neurol 2021; 12:627736. [PMID: 33815255 PMCID: PMC8018277 DOI: 10.3389/fneur.2021.627736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype. Methods: Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes. Results: The subtemporal (33.33%), retrosigmoid (16.67%), and Kawase approaches (50%) were used for the UC type. Simpson I/II resection was achieved in 46.66% of patients with the Kawase approach. Significant differences were found between the other two approaches (P = 0.044) and in the follow-up Karnofsky performance scale (KPS) scores (P = 0.008). The subtemporal (60%) and Kawase approaches (40%) were used for the CS type; neither approach achieved Simpson I/II resection. The retrosigmoid (25.81%) and Kawase approaches (74.19%) were used for the TE type. The Simpson I/II resection rates of the two approaches were 55.55 and 86.95%, respectively, and a significant difference was observed between them (P = 0.039). The retrosigmoid (43.75%) and Kawase approaches (56.25%) were used for the PA type. The Simpson I/II resection rates of the two approaches were 31.25 and 50%, respectively. The resection degrees of the two approaches and the KPS scores at follow-up were significantly different (P = 0.034). Conclusion: The individual microsurgical approaches adopted for the various PM tumor subtypes can provide maximal safe resection and good KPS scores. The Kawase approach is more suitable for PM, especially for UC- and PA-type PM tumors.
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Affiliation(s)
- Yazhou Lin
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Gao
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huiping Jin
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Nana Wang
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Dingkang Xu
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - A Bao Guo
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Weidong Zang
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Zhihua Li
- College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Fuyou Guo
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Surgical Outcome of Trigeminal Schwannomas. Cancers (Basel) 2021; 13:cancers13061310. [PMID: 33804067 PMCID: PMC8002014 DOI: 10.3390/cancers13061310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Trigeminal schwannomas are the most common among non-vestibular schwannomas. Treatment of trigeminal schwannomas may be challenging due to critical anatomical relations and involvement of different aspects of the skull base. Advances in microsurgery have led to improved outcomes over the last decades, whereas in contrast, some advocate stereotactic radiotherapy as an effective therapy, controlling the tumor volume with few complications. In this manuscript, we present outcome and adverse events in a contemporary cohort of trigeminal schwannomas and discuss surgical advantages and disadvantages of different performed classic skull-base approaches. Abstract (1) Background: As resection of trigeminal schwannomas is challenging, due to anatomical involvement of the anterior, middle and posterior fossa, the appropriate approach is important. We report our experience with surgical resection of trigeminal schwannomas by simple and classic skull-base approaches. (2) Methods: We performed a retrospective single-center study including patients who underwent surgery for trigeminal schwannoma tumors between June 2007 and May 2020, concentrating on surgical technique, extent of resection, postoperative outcome and complications. (3) Results: We included 13 patients (median age 57.5 with range of 36-83 years, 53.8% (7/13) female. The most common preoperative clinical presentations were facial pain in six (46.2%), hypoacusis in four (30.8%), trigeminal nerve hypesthesia in 11 (V1 46.2% (6/13), V2 (61.5% (8/13), V3 46.2% (6/13)) and headache in three (23.1%) patients. In three cases, the tumor was resected in a two-stage technique. The intradural subtemporal approach was performed in six cases, the extradural technique in two cases, the retrosigmoid approach in five cases, a Kawase approach in two cases and the transnasal endoscopic approach in one case. The gross total resection rate was 76.9% (10/13) and the median follow-up time 24.0 (0–136) months. Three (23.1%) patients developed postoperative anesthesia in at least one branch of the trigeminal nerve. Trigeminal motor function was preserved in 11 (84.6%) patients. Ten of the 11 patients (76.9%) who reported decreased gustation, cerebellar ataxia, visual impairment, or headache improved postoperatively. Two (15.4%) patients exhibited minimal facial palsy (House and Brackmann II–III), which resolved during the follow-up. The total adverse event rate requiring surgical intervention during follow-up was 7.7%. Surgery-related mortality was 0%. (4) Conclusions: Trigeminal schwannomas are rare benign lesions with intra- and extracranial extension. Considering the low operative morbidity and satisfying functional outcome, gross total resection of trigeminal schwannomas is achievable by classic, but also individually tailored approaches. More invasive or combined techniques were not needed with meticulous surgical planning.
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Suárez C, López F, Mendenhall WM, Andreasen S, Mikkelsen LH, Langendijk JA, Bondi S, Rodrigo JP, Bäck L, Mäkitie AA, Fernández-Alvarez V, Coca-Pelaz A, Smee R, Rinaldo A, Ferlito A. Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas. Cancer Manag Res 2021; 13:463-478. [PMID: 33500660 PMCID: PMC7822088 DOI: 10.2147/cmar.s287410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/30/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5–10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stefano Bondi
- Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | | | - Andrés Coca-Pelaz
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Endonasal endoscopic removal of a large intracranial infratemporal fossa trigeminal schwannoma: A case report and literature review. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Almomen A, Alyousif A, Ali Z, Al Yaeesh I, AlOmirin A, Al Yahya A, AlSuqair H, Almolani F. Image-guided endonasal endoscopic excision of Meckel's cave trigeminal schwannoma from cavernous and petrous carotid artery. J Surg Case Rep 2020; 2020:rjaa374. [PMID: 33024535 PMCID: PMC7526469 DOI: 10.1093/jscr/rjaa374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Trigeminal schwannoma is the second most common schwannoma after vestibular schwannoma. Symptoms vary depending on the anatomical structures affected by the tumor, including facial pain, paresthesia, dizziness and ataxia. The primary goals are controlling the symptoms and the maintenance of cranial nerves’ integrity perioperatively. We report a 39-year-old lady who was complaining of mild right-sided headache, vision and hearing loss, right facial weakness and dysphagia. CT and MRI showed a large dumbbell-shaped tumor originating from the trigeminal fossa abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa. An image-guided endonasal endoscopic removal was successfully done. Image-guided endonasal endoscopic removal of a trigeminal schwannoma abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa is a safe, effective approach, as it offers excellent visualization, accurate localization and safe dissection of the tumor from the critical anatomical neurovascular structures surrounding it.
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Affiliation(s)
- Ali Almomen
- Rhinology and Skull Base Surgery, KFSH, MOH, Dammam, Saudi Arabia
| | | | - Zainab Ali
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | | | | | - Fadhel Almolani
- Interventional and Neuroradiology, KFSH, MOH, Dammam, Saudi Arabia
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Park HH, Hong SD, Kim YH, Hong CK, Woo KI, Yun IS, Kong DS. Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg 2020; 133:467-476. [PMID: 31226689 DOI: 10.3171/2019.3.jns19492] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Trigeminal schwannomas are rare neoplasms with an incidence of less than 1% that require a comprehensive surgical strategy. These tumors can occur anywhere along the path of the trigeminal nerve, capable of extending intradurally into the middle and posterior fossae, and extracranially into the orbital, pterygopalatine, and infratemporal fossa. Recent advancements in endoscopic surgery have suggested a more minimally invasive and direct route for tumors in and around Meckel's cave, including the endoscopic endonasal approach (EEA) and endoscopic transorbital superior eyelid approach (ETOA). The authors assess the feasibility and outcomes of EEA and ETOA for trigeminal schwannomas. METHODS A retrospective multicenter analysis was performed on 25 patients who underwent endoscopic surgical treatment for trigeminal schwannomas between September 2011 and February 2019. Thirteen patients (52%) underwent EEA and 12 (48%) had ETOA, one of whom underwent a combined approach with retrosigmoid craniotomy. The extent of resection, clinical outcome, and surgical morbidity were analyzed to evaluate the feasibility and selection of surgical approach between EEA and ETOA based on predominant location of trigeminal schwannomas. RESULTS According to predominant tumor location, 9 patients (36%) had middle fossa tumors (Samii type A), 8 patients (32%) had dumbbell-shaped tumors located in the middle and posterior cranial fossae (Samii type C), and another 8 patients (32%) had extracranial tumors (Samii type D). Gross-total resection (GTR, n = 12) and near-total resection (NTR, n = 7) were achieved in 19 patients (76%). The GTR/NTR rates were 81.8% for ETOA and 69.2% for EEA. The GTR/NTR rates of ETOA and EEA according to the classifications were 100% and 50% for tumors confined to the middle cranial fossa, 75% and 33% for dumbbell-shaped tumors located in the middle and posterior cranial fossae, and 50% and 100% for extracranial tumors. There were no postoperative CSF leaks. The most common preoperative symptom was trigeminal sensory dysfunction, which improved in 15 of 21 patients (71.4%). Three patients experienced new postoperative complications such as vasospasm (n = 1), wound infection (n = 1), and medial gaze palsy (n = 1). CONCLUSIONS ETOA provides adequate access and resectability for trigeminal schwannomas limited in the middle fossa or dumbbell-shaped tumors located in the middle and posterior fossae, as does EEA for extracranial tumors. Tumors predominantly involving the posterior fossa still remain a challenge in endoscopic surgery.
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Affiliation(s)
| | | | - Yong Hwy Kim
- 3Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - In-Sik Yun
- 5Plastic Surgery, Gangnam Severance Hospital, Yonsei University Health System; Departments of
| | - Doo-Sik Kong
- 6Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine; and
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SIMULTANEOUS REMOVAL OF THE NEURINOMA OF THE TRIPLE NERV, LOCALIZED IN THE BACK, MIDDLE, AND SECULAR PITS. CLINICAL OBSERVATION AND REVIEW OF LITERATURE. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the study is to consider and show the possibilities of methods for surgery of skull base tumors using the example of successful surgical treatment of a patient with widespread trigeminal neuroma located in the posterior, middle and temporal fossae, as well as to analyze international scientific experience on this issue.
Materials and methods. In February 2020, a 60-year-old patient with widespread trigeminal neuroma on the left was admitted to the Federal Scientific-Clinical Center of FMBA of Russia in February 2020. After additional examination and preoperative preparation, a planned operation was performed - osteoplastic orbitozygomatic trepanation of the skull, microsurgical removal of the tumor through subtemporal transcavernous access. A good postoperative clinical result was obtained. An analysis of the available scientific literature on this problem is carried out.
Results. In the postoperative period, pain and neurological symptoms, hemifacial spasm completely regressed. 1.5 months after the operation, the tumor was totally removed in the control images. In the course of the analysis of available foreign and domestic literature, 65 observations of trigeminal tumors with extracranial growth were found, the total removal of which was performed only in 20% of patients.
Conclusion. Despite the extreme complexity of the pathology, the operation through the orbitozygomatic subtemporal transcavernous access allows you to completely remove the common and giant trigeminal neuromas with a good functional result.
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