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J Neurol Surg B Skull Base 2016; 77(04): 371-378
DOI: 10.1055/s-0036-1581138
NASBS Noteworthy Panel
Georg Thieme Verlag KG Stuttgart · New York

Multimodality Management of Trigeminal Schwannomas

Ajay Niranjan
1   Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Samuel Barnett
2   Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, United States
,
Vijay Anand
3   Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, United States
,
Siviero Agazzi
4   Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
› Author Affiliations
Further Information

Publication History

07 November 2015

17 February 2016

Publication Date:
22 April 2016 (online)

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Abstract

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

Note

This article is based on the Panel discussion “Trigeminal Schwannomas” at the 2015 NASBS Annual Meeting.


 

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