Trigeminal Schwannoma: A Retrospective Analysis of Endoscopic Endonasal Management, Treatment Outcomes, and Neuropathic Sequelae

Abstract

Introduction Trigeminal schwannomas (TS) are rare skull base tumors that have been associated with significant neuropathic sequalae for patients. The authors aim to evaluate the clinical features, treatment outcomes, and neuropathic sequelae following endoscopic endonasal approach (EEA) for TS.

Methods The study involves a retrospective review of patients who underwent EEA for resection of TS at a single academic institution between 2004 and 2020. Radiographic and clinical data were recorded and analyzed.

Results A total of 16 patients were abstracted, with a mean age at the time of surgery of 44 years with a slight female (1.83:1) predominance. Primary preoperative symptomatology included facial pain/neuralgia (n = 5, 31.3%), facial hypoesthesia (n = 4, 25.0%), and headache (n = 4, 25.0%). Following TS resection, patients were found to have facial hypoesthesia (n = 11, 68.8%), neuropathic keratopathy (n = 4, 25.0%), and mastication musculature atrophy (n = 3, 18.8%). Patients with preoperative facial pain/neuralgia (n = 5, 31.3%) were significantly more likely to try adjunctive pain therapies (p = 0.018) as well as seek pain consultation (p = 0.018). Patients with preoperative migraines (n = 2, 12.5%) were significantly more likely to trial adjunctive pain therapies (p = 0.025) and undergo evaluation with pain specialists (p = 0.025). Finally, patients with preoperative pharmacologic agent utilization were significantly more likely to trial adjunctive pain therapies (p = 0.036) and pursue pain consultation (p = 0.036).

Conclusion Some degree of trigeminal dysfunction may be more common than previously reported following EEA for TS resection. Factors that appear to play a role in the development of trigeminal dysfunction include pre-existing pain syndromes such as facial pain/neuralgia or headache and preoperative medication utilization.

Keywords

endoscopic endonasal approach - trigeminal neuropathy - outcomes - trigeminal nerve - trigeminal schwannoma

Note

This manuscript was presented as a virtual on-demand presentation at the North American Skull Base Society Annual Meeting on February 13, 2021.

Publication History

Received: 19 March 2022

Accepted: 20 June 2022

Article published online:
15 September 2022

• References

• 1 Lesoin F, Rousseaux M, Villette L. et al. Neurinomas of the trigeminal nerve. Acta Neurochir (Wien) 1986; 82 (3-4): 118-122
• 2 Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas. J Neurosurg 1995; 82 (05) 711-718
• 3 Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg 1999; 91 (02) 202-211
• 4 Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clin Neurosurg 1953; 1: 11-54
• 5 Arseni C, Dumitrescu L, Constantinescu A. Neurinomas of the trigeminal nerve. Surg Neurol 1975; 4 (06) 497-503
• 6 Schisano G, Olivecrona H. Neurinomas of the Gasserian ganglion and trigeminal root. J Neurosurg 1960; 17: 306-322
• 7 Cushing HEL. Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Ill: Charles C Thomas; 1938
• 8 Shin SS, Gardner PA, Stefko ST, Madhok R, Fernandez-Miranda JC, Snyderman CH. Endoscopic endonasal approach for nonvestibular schwannomas. Neurosurgery 2011; 69 (05) 1046-1057 , discussion 1057
• 9 Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH. Surgical management of trigeminal schwannomas: defining the role for endoscopic endonasal approaches. Neurosurg Focus 2014; 37 (04) E17
• 10 Karligkiotis A, Turri-Zanoni M, Sica E. et al. Role of endoscopic surgery in the management of sinonasal and skull base schwannomas. Head Neck 2016; 38 (Suppl. 01) E2074-E2082
• 11 Shi J, Chen J, Chen T. et al. Neuroendoscopic resection of trigeminal schwannoma in the pterygopalatine/infratemporal fossa via the transnasal perpendicular plate palatine bone or transnasal maxillary sinus approach. World Neurosurg 2018; 120: e1011-e1016
• 12 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117 (04) 699-705
• 13 Fortes FS, Sennes LU, Carrau RL. et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008; 118 (01) 44-49
• 14 Truong HQ, Sun X, Celtikci E. et al. Endoscopic anterior transmaxillary “transalisphenoid” approach to Meckel's cave and the middle cranial fossa: an anatomical study and clinical application. J Neurosurg 2018; 130 (01) 227-237
• 15 Hadad G, Bassagasteguy L, Carrau RL. et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
• 16 Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery 2003; 52 (04) 783-790 , discussion 790
• 17 Park HH, Hong SD, Kim YH. et al. Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg 2020; 133 (02) 467-476
• 18 Niranjan A, Raju SS, Kano H, Flickinger JC, Lunsford LD. Clinical and imaging response to trigeminal schwannoma radiosurgery: a retrospective analysis of a 28-year experience. J Neurol Surg B Skull Base 2021; 82 (05) 491-499
• 19 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 (03) 453-463
• 20 Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal schwannomas: skull base approaches and operative results in 105 patients. Neurosurgery 2012;70(suppl operative 1):132–143, discussion 143–144
• 21 Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemomas of the trigeminal nerve. J Neurosurg 1989; 70 (05) 737-745
• 22 MacNally SP, Rutherford SA, Ramsden RT, Evans DG, King AT. Trigeminal schwannomas. Br J Neurosurg 2008; 22 (06) 729-738
• 23 Taha JM, Tew Jr JM, van Loveren HR, Keller JT, el-Kalliny M. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 1995; 82 (05) 719-725
• 24 Tanaka S, Pollock BE, Stafford SL, Link MJ. Stereotactic radiosurgery for trigeminal pain secondary to benign skull base tumors. World Neurosurg 2013; 80 (3-4): 371-377
• 25 Guthikonda B, Theodosopoulos PV, van Loveren H, Tew Jr JM, Pensak ML. Evolution in the assessment and management of trigeminal schwannoma. Laryngoscope 2008; 118 (02) 195-203