Skull Base 2011; 21(6): 351-358
DOI: 10.1055/s-0031-1287683

© Thieme Medical Publishers

Multicompartmental Trigeminal Schwannomas: Management Strategies and Outcome

Dwarakanath Srinivas1 , Sampath Somanna1 , Chandramouli Bangalore Ashwathnarayana1 , Indira Devi Bhagavatula1
  • 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Weitere Informationen


14. September 2011 (online)


Trigeminal schwannomas (TS), though the second most common intracranial schwannomas, represent only 0.8 to 8% of all Schwannomas. Advancement in imaging and microsurgical techniques has led to a remarkable improvement in the outcome of these benign tumors. Multicompartmental TS, though extensive, have an excellent outcome after surgery. In this article, we present our experience in the management of multicompartmental TS (types middle/posterior [MP], middle/extracranial [ME], and middle/posterior and extracranial [MPE]) and outcome in this rather uncommon group of tumors. This retrospective study included all the cases of multicompartmental TS operated at our institute from 1999 to 2009. The medical data were analyzed retrospectively. The demographic profile, clinical features, radiological findings, management strategies, postoperative complications, length of hospitalization, and outcome were noted. Follow-up data were collected from outpatient department records. The range and average duration of follow-up were noted. There were a total of 43 patients with TS operated over this period. Among them, 4 were type B, 5 type C, 11 type D, 18 type E, and 5 type F. The study included 26 patients (4 type B, 18 type E, and 4 type B). A variety of approaches were used to approach the tumor. Of 26, 23 patients had a gross total or near-total excision while 2 patients were lost to follow-up. Among the three patients who had a near-total excision and follow-up magnetic resonance imaging showed a small residual tumor, two are on close follow-up with no increase in the size of the tumor over a follow-up period of 3 years, the other patient is a 5-year-old boy who is too young for radiosurgery and is on follow-up. There was no mortality while four patients have had fresh permanent postoperative deficits. Multicompartmental TS are a rare, complex but eminently treatable group of tumors. A variety of surgical approaches can be used to excise the tumor. The choice of approach needs to be individualized with total excision providing excellent results.


  • 1 Ramina R, Neto M C, Fernandes Y B, Leal A G, da Silva E B. The surgical management of trigeminal schwannomas. In: Ramina R, Aguiar H P, Tatagiba M, eds. Samii's Essentials in Neurosurgery. New York: Springer; 2008: 155-164
  • 2 Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature.  J Neurosurg. 1999;  91 (2) 202-211
  • 3 Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases.  Neurosurgery. 2003;  52 (4) 783-790 discussion 790
  • 4 Samii M, Migliori M M, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas.  J Neurosurg. 1995;  82 (5) 711-718
  • 5 Kouyialis A T, Stranjalis G, Papadogiorgakis N et al. Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae.  Acta Neurochir (Wien). 2007;  149 (9) 959-963 discussion 964
  • 6 Zhou L F, Mao Y, Zhang R. Surgical treatment of dumbbell-shaped neurinomas: report of an experience with 57 cases in a single hospital.  Surg Neurol. 2007;  68 (6) 594-602
  • 7 Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function.  J Neurosurg. 2002;  96 (3) 453-463

Dwarakanath SrinivasM.S. M.Ch. 

Associate Professor, Department of Neurosurgery, National Institute of Mental Health and Neurosciences

Hosur Road, Bengaluru 560011, India