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Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005)

 Hun Ho Park  ;  Sang Duk Hong  ;  Yong Hwy Kim  ;  Chang-Ki Hong  ;  Kyung In Woo  ;  In-Sik Yun  ;  Doo-Sik Kong 
 JOURNAL OF NEUROSURGERY, Vol.133(2) : 467-476, 2020-08 
Journal Title
Issue Date
Adult ; Aged ; Cranial Nerve Neoplasms / pathology ; Cranial Nerve Neoplasms / surgery* ; Female ; Humans ; Male ; Middle Aged ; Neurilemmoma / pathology ; Neurilemmoma / surgery* ; Neuroendoscopy / methods* ; Retrospective Studies ; Treatment Outcome ; Trigeminal Nerve / pathology ; Trigeminal Nerve / surgery* ; Trigeminal Nerve Diseases / pathology ; Trigeminal Nerve Diseases / surgery* ; Young Adult
CN = cranial nerve ; CS = cavernous sinus ; EEA = endoscopic endonasal approach ; EOR = extent of resection ; ETOA = endoscopic transorbital superior eyelid approach ; GKRS = Gamma Knife radiosurgery ; GTR = gross-total resection ; ICA = internal carotid artery ; IOF = inferior orbital fissure ; MOB = meningoorbital band ; NTR = near-total resection ; PR = partial resection ; RLS = retrosigmoid lateral suboccipital ; SOF = superior orbital fissure ; STR = subtotal resection ; classification ; endoscopic endonasal approach ; endoscopic transorbital approach ; surgical technique ; trigeminal schwannoma
Objective: Trigeminal schwannomas are rare neoplasms with an incidence of less than 1% that require a comprehensive surgical strategy. These tumors can occur anywhere along the path of the trigeminal nerve, capable of extending intradurally into the middle and posterior fossae, and extracranially into the orbital, pterygopalatine, and infratemporal fossa. Recent advancements in endoscopic surgery have suggested a more minimally invasive and direct route for tumors in and around Meckel's cave, including the endoscopic endonasal approach (EEA) and endoscopic transorbital superior eyelid approach (ETOA). The authors assess the feasibility and outcomes of EEA and ETOA for trigeminal schwannomas. Methods: A retrospective multicenter analysis was performed on 25 patients who underwent endoscopic surgical treatment for trigeminal schwannomas between September 2011 and February 2019. Thirteen patients (52%) underwent EEA and 12 (48%) had ETOA, one of whom underwent a combined approach with retrosigmoid craniotomy. The extent of resection, clinical outcome, and surgical morbidity were analyzed to evaluate the feasibility and selection of surgical approach between EEA and ETOA based on predominant location of trigeminal schwannomas. Results: According to predominant tumor location, 9 patients (36%) had middle fossa tumors (Samii type A), 8 patients (32%) had dumbbell-shaped tumors located in the middle and posterior cranial fossae (Samii type C), and another 8 patients (32%) had extracranial tumors (Samii type D). Gross-total resection (GTR, n = 12) and near-total resection (NTR, n = 7) were achieved in 19 patients (76%). The GTR/NTR rates were 81.8% for ETOA and 69.2% for EEA. The GTR/NTR rates of ETOA and EEA according to the classifications were 100% and 50% for tumors confined to the middle cranial fossa, 75% and 33% for dumbbell-shaped tumors located in the middle and posterior cranial fossae, and 50% and 100% for extracranial tumors. There were no postoperative CSF leaks. The most common preoperative symptom was trigeminal sensory dysfunction, which improved in 15 of 21 patients (71.4%). Three patients experienced new postoperative complications such as vasospasm (n = 1), wound infection (n = 1), and medial gaze palsy (n = 1). Conclusions: ETOA provides adequate access and resectability for trigeminal schwannomas limited in the middle fossa or dumbbell-shaped tumors located in the middle and posterior fossae, as does EEA for extracranial tumors. Tumors predominantly involving the posterior fossa still remain a challenge in endoscopic surgery.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Yun, In Sik(윤인식) ORCID logo https://orcid.org/0000-0003-1103-7047
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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