The Microsurgical Strategies Of Trigeminal Schwannoma

Objective:To explore the surgical approach selection for microsurgical treatment of trigeminal schwannoma,as well as the operation key points,advantages and disadvantages of each surgical approach.Methods:By reviewing the literature and retrospectively analyzing the clinical data of 39 TS patients admitted to the Department of Neurosurgery of the First Hospital of Jilin University from January 2013 to December 2019.According to the Sammi imaging classification,39 cases were divided into 3 types,type A: 12 cases;type B: 12 cases;type C: 15 cases.All cases were accepeted microneurosurgery with different surgical approaches.All cases were confirmed by postoperative pathology.Head MRI was performed3 to 6 months after the operation.Results:In this 39 cases,total resection: 36 cases(36/39,92.3%),sub-total resection:3 cases(3/39,7.7%).The 3 cases of sub-total excision were All C-type tumors,of which 2 cases were tumor residue in the cavernous sinus area and 1 was Meckel's cavity with tumor residue.1 of the 2 cases of cavernous sinus residual tumor was accepted radiotherapy,and there was no significant progress in the review of these 2 cases.Meckel's cavity tumor residual case relapsed after 2 years and was accepted operation again.Conclusion:Through detailed evaluation of the patients' clinical symptoms and preoperative imaging examination,we clarified the characteristics of the tumor location,adjacent relationship and growth direction,combined with the surgeon's experience,and selected the appropriate surgical approach for microneurosurgical treatment.For type A TS,use the subtemporal intradural approach or the extradural approach through the middle cranial fossa.For type B TS,suboccipital-retrosigmoid approach is used.For type C TS,if the middle cranial fossa tumor is the main body,then choose the subtemporal intradural approach or the extradural approach through the middle cranial fossa.For type C TS,if the posterior cranial fossa tumor is the main body and the invasion to the cavernous sinus area is limited,the suboccipital-retrosigmoid approach is adopted.