Outcomes following Surgical Resection of Trigeminal Schwannomas: A Systematic Review and Meta-analysis

Introduction: Although typically benign, trigeminal schwannomas (TS) may require surgical resection when large or symptomatic, and can cause significant morbidity.

Objective: This article aims to summarize the literature and synthesize outcomes following surgical resection of TS.

Methods: 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.

Results: The initial search yielded 1838 results, of which 26 studies with 974 patients undergoing surgical resection of TS were included. Mean age was 42.9 years and 58.0% were female. 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%). 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 significant lower odds of recurrence/progression (OR: 0.07; 95% CI: 0.04–0.15) compared to patients with non-GTR.

Conclusion: This systematic review and meta-analysis reports patient outcomes following surgical resection of TS. EOR was found to be an important predictor of risk of recurrence. Facial pain was more likely to improve postoperatively than facial hypesthesia. This work reports baseline rates of postoperative complications across studies, establishing benchmarks for neurosurgeons innovating and working to improve surgical outcomes for TS patients.

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Artikel online veröffentlicht:
07. Februar 2025