Multimodality Management of Trigeminal Schwannomas and Quality of Life Outcomes-A Single Institution Experience

Background: Trigeminal schwannomas are the second most common among intracranial schwannomas. These can arise from anywhere between the root and the distal extracranial branches of the trigeminal nerve. Clinical presentation depends on location and size, including but not limited to facial hypoesthesia or pain, headaches, dizziness, ataxia, and diplopia. Literature is strikingly scant discussing the natural history of these lesions, while the treatment goals are heavily dependent on tumor presentation. Management decisions have to be individualized to each tumor and each patient, while attempting to maximize the quality of life. We present a unique look at single institution management of these lesions, whether by surgery, radiation, or by serial imaging, report on the quality of life of patients diagnosed with trigeminal schwannomas.

Methods: Between 2001 and 2015, 28 patients (64.3% female) with trigeminal schwannomas were diagnosed and managed with trigeminal schwannomas at Vancouver General Hospital. We analyzed the clinical presentation, surgical results, resection rates, patient quality of life, and complications. To complete the evaluation, we prospectively collected SF-36 Quality of Life assessments from patients and compared post-treatment quality of life assessments with those completed by patients at the time of the initial clinic visit.

Results: We were able to identify 12 patients treated with a craniotomy and surgical resection, 6 who had radiation treatment, while 10 patients were followed by observation. Mean age of study cohort was 52.1 years (range 23–82 years), and most patients presented with facial hypoesthesia (53.6%) and headaches (39.3%) while 32.1% were incidental. There were no major differences in patient demographics between three groups. Patients offered surgery had larger lesions (mean diameter 3.4 cm) when compared with those that were irradiated or observed, and were more likely to have extracranial extension. There were no neurologic or medical complications of surgical treatment, while 66.7% patients had worsening of symptoms following radiation treatment requiring steroid use. Overall patient quality of life perception improved in the cohort following surgery (ΔSF-36 +8.4), while those patients that underwent radiation or were observed started with an overall higher SF-36 score (66.1 and 61.1 respectively).

Conclusions: The treatment goals of trigeminal schwannomas focus on improvement in neurologic symptoms, relief of mass effect, and preservation of cranial nerve function. These must be balanced against preservation of patient quality of life, which we demonstrate only marginally improves with treatment interventions. Individualization of management strategies on a case by case bases should be conceptualized by a dedicated skull base team. Where possible, a complete surgical resection should be the treatment of choice but advancements in radiosurgical techniques have opened up possibilities for primary management of smaller lesions as well as for postoperative residuals or recurrences.

No conflict of interest has been declared by the author(s).