Surgical treatment strategies of middle skull base trigeminal schwannoma with extracranial extension

Bai Jingmin; Meng Xiaoli; Wan Jinghai; Wu Yuehuang

doi:10.11850/j.issn.1009-122X.2017.05.001

Abstract：Objective To investigate the clinical features and surgical treatment strategies of middle skull base trigeminal schwannoma with extracranial extension. Methods The clinical and imaging features, surgical resection and follow-up data of 18 patients suffering middle skull base trigeminal schwannoma with extracranial extension were analyzed retrospectively. The middle skull base trigeminal schwannoma with extracranial extension was diagnosed by surgery and pathology. Results All the tumors were totally resected by one-stage. Clinical symptoms were improved in 12 patients, no change was seen in 3 and worsened in 3. Cerebrospinal fluid leakage occurred in 1 patient, incision bleeding in 3 and epidural hematoma in 1. All of the complications were cured in the hospital. By postoperative pathology, benign tumor was revealed in 14 patients and malignant in 4. The 4 patients with malignant tumor received radiotherapy after surgery. All the patients were followed up for 31.4 months averagely. Among the 4 patients with malignant tumor, 1 patient was lost, 1 patient died, 2 patients underwent one more time surgery because of tumor recurrence. No recurrence was observed in the patients with benign tumor. Conclusions A middle skull base trigeminal schwannoma with extracranial extension usually has large tumor volume. A tumor which is mainly in the middle fossa can be resected via middle cranial fossa extradural approach. Otherwise, the tumor with larger extracranial extension can be resected via maxillary swing approach or endoscopic skull base surgery. Due to its high rate of malignancy, this kind of tumor should be totally resected. Radiotherapy is helpful to prevent its recurrence.