Patients presenting with trigeminal schwannomas require multimodality management by
a skull base surgical team that can offer expertise in both transcranial and transnasal
approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic
symptoms, preservation of cranial nerve function, and control of mass effect are the
primary goals of management for trigeminal schwannomas. Complete surgical resection
is the treatment of choice but may not be possible in all cases. Radiosurgery is an
option as primary management for small- to moderate-sized tumors and can be used for
postoperative residuals or recurrences. Planned surgical resection followed by SRS
for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic
resection is an excellent approach for patients with an extradural tumor or tumors
isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based
on high-quality imaging can help better estimate the expected outcome from each treatment.
An expert skull base team should be able to provide precise counseling for each patient's
situation for selecting the best option.
Keywords
trigeminal schwannomas - radiosurgery - skull base - transnasal approaches - endoscopic
resection
