Surgical Resection for Trigeminal Schwannomas: An Institutional Experience

Background: Trigeminal schwannomas are the most common nonvestibular intracranial schwannomas. Microsurgical resection is a mainstay of the management of trigeminal schwannoma (TS).

Objective: To describe clinical characteristics and outcomes in patients undergoing surgical resection for TS in an institutional cohort.

Methods: Retrospective study of patients undergoing TS resection (2003–2023). Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods.

Results: Twenty patients undergoing TS resection during the study period were included. Age at time of surgery ranged from 21–68 years with a median of 42 years. Ten (50%) patients were female. One (5%) patient presented with a recurrent tumor requiring repeat resection, and two (10%) patients underwent salvage surgery following failure of prior stereotactic radiosurgery (SRS). Tumor size ranged from 1.8 to 8.3 cm, with a median of 3.3 cm. Most tumors were Samii type C (60%), followed by type A (15%), B (15%), and D (10%). On MRI, four (20%) tumors were homogenous, two (10%) were cystic, and 14 (70%) were homogenous. Eight (40%) patients received gross total resection (GTR). The most common surgical approach was supratentorial (35%), followed by a combined/staged approach (25%), endoscopic (15%), infratentorial (15%), and anterior petrosectomy (10%). Intraoperative neuromonitoring (IOM) was used in 14 (70%) cases and increased auditory brainstem response latency were seen in two (14%) of those cases. The most common perioperative complication was cranial nerve injury in six (30%) patients. During a median radiographic follow-up of 53 (range 9–237. months, two patients experienced postoperative tumor progression at 38 and 152 months respectively. Trigeminal hypesthesia was the most common presenting symptom, present in 50% of patients, followed by ataxia/cerebellar signs (25%) and facial pain (25%). At the last clinical follow-up (median (range): 47 (1–238) months), 16 (80%) patients reported subjective improvement in all presenting symptoms.

Conclusion: Surgical resection of TS was associated with good progression-free survival and symptom improvement in our cohort, but cranial neve injuries were a common perioperative complication in this patient population.

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Artikel online veröffentlicht:
05. Februar 2024