Management of large Trigeminal Schwannoma: long-term oncologic and functional outcome from a multicentric retrospective cohort.

Autor: Choucha A; Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France. anis.c13@gmail.com.; Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, Marseille, France. anis.c13@gmail.com., Troude L; Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Morin L; Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, |27 bd Jean Moulin cedex 05, Marseille, France., Fernandes S; Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, |27 bd Jean Moulin cedex 05, Marseille, France., Baucher G; Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France., De Simone M; Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via S. Allende, 84081, Baronissi, Italy., Lihi A; CHU Angers-Neurochirurgie, 4, rue Larrey, 49033, Angers Cedex 3, France.; Faculté de Médecine, Laboratoire d'Anatomie, Université Angers, rue Haute de Reculée, 49045, Angers, France., Mazen K; Neurosurgery Unit, CHU Grenoble-Alpes, Grenoble, France., Alseirihi M; Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France., Passeri T; Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Gay E; Neurosurgery Unit, CHU Grenoble-Alpes, Grenoble, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Fournier HD; CHU Angers-Neurochirurgie, 4, rue Larrey, 49033, Angers Cedex 3, France.; Faculté de Médecine, Laboratoire d'Anatomie, Université Angers, rue Haute de Reculée, 49045, Angers, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Jacquesson T; Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Jouanneau E; Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Froelich S; Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.; French Society of Neurosurgery - Skull Base S, Paris, France., Roche PH; Department of Neurosurgery, Aix Marseille Univ, APHM, UH North, Chemin des Bourrely, 13015, Marseille, France.; French Society of Neurosurgery - Skull Base S, Paris, France.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Nov 05; Vol. 166 (1), pp. 440. Date of Electronic Publication: 2024 Nov 05.
DOI: 10.1007/s00701-024-06292-8
Abstrakt: Objective: Trigeminal schwannoma (TS), though a rare and benign tumor, becomes a significant surgical challenge due to its intricate location. This study aims to detail the long-term functional outcomes and tumor control post-surgical resection.
Method: We analyzed a multicentric retrospective cohort of 39 patients operated on for a TS in five tertiary centers between January 1993 and July 2022.
Results: Six TS (15%) were in the middle fossa (type M), two (5%) in the posterior fossa (type P), and two (5%) were extracranial (type E). Twenty-nine (75%) were Dumbbell shape: Eighteen (47%) were MP type, seven (18%) were MPE type, and four (10%) were ME type. Fifth nerve symptoms were the foremost preoperative complaint: hypesthesia (51%), trigeminal neuralgia (36%), and paresthesia (30%). We report a favorable evolution course for 61% of preexisting deficits (half of patients with preoperative paresthesia and neuralgia improved while only 5% of preoperative hypesthesia improved). Postoperative hypesthesia was the most frequent de novo deficit 14 (74%) and resolved in solely half the cases. Various approaches were used according to tumor type. Gross total resection (GTR), Subtotal resection (STR), and partial resection (PR) were achieved in respectively 33% (N = 13), 10% (N = 4), and 56% (N = 22) of patients. The mean clinical and radiological FU was 63 months (12 - 283 months). GTR led to no sign of recurrence (mean FU: 60 months - range: 12-283 months). For STR or PR (67%): 23 (88%) were assigned to a Wait-&-rescan policy (WS group) which offered stability in 70% (N = 16). Three cases (8%) underwent a complementary GKS (GammaKnife) on the residual lesion (GK group) without tumor change.
Conclusion: For large TS, the completeness of resection must consider the potential functional burden of surgery. With giant infiltrating lesions, a strategy of planned subtotal resection, complemented by radiosurgery, either complementary or uppon regrowth, may provide similar oncological outcomes.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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