Microsurgical Management of Trigeminal Schwannoma: Cohort Analysis and Systematic Review

Abstract Background: Trigeminal Schwannomas are benign tumors with a predilection for women between 40 to 60 years of age and account for less than 0.5% of all intracranial tumors. Clinical presentation depends on size and location and typical symptoms are ipsilateral hypesthesia, headache, and facial pain. The Diagnosis is usually made by clinical features and imaging.

Methods: A retrospective cohort analysis of fourteen patients treated at our institution between January 1999 and October 2016 was carried out, with critical and systematic review of data from literature, focusing on articles published over the same period.

Results: Fourteen patients were included in our series comprised of mostly women with a mean age 40 years. Lesion size ranged from 3cm to 6.5cm (mean 4.6 cm). Clinical status of patients was evaluated and also rated based on the Karnovsky Performace Score with values greater than 90% found in all patients pre- and postoperatively. Surgery was our treatment of choice and gross total resection was achieved in 71% of patients. Associated morbidity was high at 57%, predominantly from cranial nerve palsy, and no deaths were encountered.

Conclusions: Microsurgery is a suitable treatment for large symptomatic trigeminal schwannomas achieving good local control rates over the observation period at acceptable morbidity. Therefore, microsurgery appears to a suitable option During the study period, a significant evolution in available of treatment methods occurred. Radiosurgery emerged as an alternative treatment for unresectable lesions. A comprehensive review of the available literature was performed and results were compared according to treatment modality.