Ramina Ricardo, Mattei Tobias A, Sória Marília G, da Silva Erasmo B, Leal André G, Neto Maurício C, Fernandes Yvens B
Department of Neurosurgery, Instituto de Neurologia de Curitiba, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Neurosurg Focus. 2008;25(6):E6; discussion E6. doi: 10.3171/FOC.2008.25.12.E6.
The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension.
A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year.
Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively.
The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.
作者对三叉神经鞘瘤（TSs）的手术治疗进行了详细综述，并基于手术解剖结构和肿瘤扩展情况讨论了最佳手术入路。
报告了1987年至2008年期间在作者所在机构接受手术治疗的一系列17例TSs患者。病变大小为2例小（<3 cm）、5例中等（3至4 cm之间）、6例大（>4 cm）、4例巨大（>5 cm）。术前症状包括三叉神经感觉减退（53%）、面部疼痛（53%）、头痛（35.3%）、听力障碍（17.6%）、癫痫发作（17.6%）、复视（11.8%）、共济失调（11.8%）以及偏瘫和伴有视乳头水肿的颅内压升高（5.9%）。平均随访时间为10.5年（121.6个月），平均每年0.8例患者。
16例患者实现了肿瘤全切，无手术相关死亡。7例出现术后三叉神经麻醉；7例保留了三叉神经运动功能。2例发生脑脊液漏，2例出现轻度面神经麻痹，1例2型神经纤维瘤病患者肿瘤复发，再次手术顺利切除。报告有面部疼痛的9例患者中，术后仅1例仍有症状。
TSs的最佳治疗方法是完整的显微手术切除。在成熟的颅底神经外科中心进行病变切除时，术后有可能保留三叉神经功能。尽管放射外科治疗已报告有良好效果，但这种治疗方式无法治愈。相反，这种治疗应仅保留用于海绵窦内不可切除和残留的肿瘤。
