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Trigeminal Schwannomas: Skull Base Approaches and Operative Results in 105 Patients

Wanibuchi, Masahiko MD, PhD*,‡,§; Fukushima, Takanori MD, DMSc‡,§; Zomordi, Ali R. MD§; Nonaka, Yoichi MD, PhD‡,§; Friedman, Allan H. MD§

Neurosurgery:
doi: 10.1227/NEU.0b013e31822efb21
Surgical Anatomy and Technique: Editor's Choice
Editor's Choice
Abstract

BACKGROUND: Trigeminal schwannomas make up 0.8% to 8% of all intracranial schwannomas.

OBJECTIVE: To analyze our surgical experience with trigeminal schwannomas.

METHODS: We performed 107 operations on 105 patients harboring trigeminal schwannomas over the past 30 years. We classified the tumors as peripheral, ganglion cavernous, posterior fossa root, and dumbbell types according to the portion of the nerve that gave rise to the tumor.

RESULTS: Fourteen were peripheral-type tumors (13.1%), 39 (36.4%) were ganglion cavernous type, 22 (20.6%) were posterior fossa root type, and 32 (30.0%) were dumbbell type. Sixty-five tumors were solid, 35 were mixed, and only 7 were cystic. Among solid tumors, 14 were vascular, fibrous, and adherent to adjacent structures. Total or near-total removal was performed in 86 cases (81.9%), and subtotal removal was achieved in 18 (17.1%). The most common symptom was facial hypesthesia, occurring in 69 patients. This symptom improved in 11 patients, persisted in 50 patients, and worsened in 8 patients after surgery. New postoperative hypesthesia was observed in 8 patients. The second most common symptom was facial pain, observed in 24 patients. Facial pain subsided in 22 and persisted in 2 patients after surgery. Diplopia was observed in 21 patients. This symptom improved postoperatively in 14 patients, persisted in 6 patients, and worsened in 1 patient.

CONCLUSION: The present series demonstrates acceptable results using microsurgical treatment to remove trigeminal schwannomas. Pain and diplopia may be relieved after surgery; however, hypesthesia frequently remains or may be worsened by surgery.

Author Information

*Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan

Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina

§Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina

Correspondence: Masahiko Wanibuchi, MD, PhD, Department of Neurosurgery, Sapporo Medical University School of Medicine, South 1 West 16, Sapporo, Hokkaido 080-8543, Japan. E-mail: wanibuti@sapmed.ac.jp or wanibuti@hotmail.co.jp

Received February 21, 2010

Accepted March 25, 2011

Copyright © by the Congress of Neurological Surgeons