Microsurgical Treatment Of Trigeminal Schwannomas

Objective: To investigate the clinical characteristics and surgical approaches of patients with trigeminal schwannomas.Methods: To review relating documents and to retrospect and analyse the clinical symptoms and signs, image characteristics and surgical approaches of 19 patients with trigeminal schwannomas. These patients had all been treated by surgical resection between June 2001 and December 2007 in the First Affiliated Hospital of Guang Xi Medical University.Results: According to the trigeminal schwannomas typing of Gwak, among the 19 patients, there are 5 cases belong to type M and 4 cases belong to type mP. These schwannomas were resected via subtemporal approach, the cranial nerve functions were improved after operation in 5 cases, 3 cases in the type M were resected subtotally in which a little schwannomas remained in the cavernous sinuses; 4 cases of type Mp were resected totally, trochlear nerve paralysis occurred in 1 case. There are 2 cases belong to type M=P and 2 cases belong to type mP, they were totally resected via presigmoid approach, the cranial nerve functions were improved after operation in 3 cases, abducent nerve paralysis occurred in 1 case, and leakage of cerebrospinal fluid occurred in another case, by lumbar draining and antibiotic therapy, the patient fully recovered. There are 6 cases belong to type P, they were totally resected via retrosigmoid approach, the cranial nerve functions were improved after operation in 5 cases, facial paralysis occurred in 1 case, and leakage of cerebrospinal fluid occurred in another case, by lumbar draining and antibiotic therapy, the patient fully recovered.Conclusion: 1. The patients with trigeminal schwannomas have their obvious clinic characters, their clinical presentations are functional impairments of trigeminal nerve or the adjacent cranial nerves or the adjacent brain tissue and the symptoms of increased intracranial pressure; their image features are the occupying lesions with clear border in the middle fossa or the posterior fossa or both. 2. It is significant to choose individual surgical approach according to trigeminal schwannomas's imageology characters. To type M and Mp, it's good to resect them via subtemporal approach; to type M=P and mP, presigmoid approach is a good choice; and to type P, the suitable surgical approach is retrosigmoid approach. By such surgical approaches, the trigeminal schwannomas are resected totally or subtotally, most patients have good prognosis.