Department of Neurosurgery, Kartal Dr. Lutfi Kirdar Research and Education Hospital, Istanbul, Turkey; Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
World Neurosurg. 2022 Jun;162:e288-e300. doi: 10.1016/j.wneu.2022.03.006. Epub 2022 Mar 9.
Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. No consensus has yet been made for surgical intervention because of the low number of reported cases of trochlear nerve schwannomas. This study comprises a systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas.
Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature and presented patients of any age who underwent surgical treatment for trochlear schwannoma. Data extracted from the included studies were combined with our experience.
Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after our experience was added. The most common symptoms were diplopia (62.2%), headache (46.7%), and motor weakness (37.8%). Mean age during the diagnosis was 45.1 years. Although the subtemporal transtentorial approach (n = 14) is the most preferred method, its application has decreased in recent years. In the last decade, the lateral suboccipital approach (n = 11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of patients. The probability of neurologic deficit was not statistically associated with tumor volume (P = 0.914), location (P = 0.669), or resection rate (P = 0.554).
Although trochlear schwannomas are rare and their treatment involves challenges, total resection with the proper approach provides the most desirable results.
颅神经神经鞘瘤几乎均起源于感觉或混合神经。运动颅神经，如滑车神经，很少与神经鞘瘤相关。由于报道的滑车神经神经鞘瘤病例较少，因此尚未达成手术干预的共识。本研究对滑车神经神经鞘瘤的文献进行了系统回顾，并结合我们的治疗经验。
无时间限制地在三个数据库（Web of Science、PubMed 和 Cochrane Library）中进行了搜索。纳入的研究必须为发表在英文文献中、并报告了任何年龄接受滑车神经鞘瘤手术治疗的患者。从纳入的研究中提取的数据与我们的经验相结合。
41 项研究共纳入 43 例患者，符合纳入标准。加入我们的经验后，患者总数为 45 例。最常见的症状是复视（62.2%）、头痛（46.7%）和运动无力（37.8%）。诊断时的平均年龄为 45.1 岁。尽管经颞下入路（n=14）是最常用的方法，但近年来其应用有所减少。在过去十年中，外侧枕下入路（n=11）越来越受欢迎。81%的患者术后滑车神经仍存在缺陷。神经功能缺损的概率与肿瘤体积（P=0.914）、位置（P=0.669）或切除率（P=0.554）无关。
尽管滑车神经鞘瘤罕见，且其治疗存在挑战，但采用适当的方法进行全切除可获得最佳效果。
