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Halalmeh DR, Asad MY, Atallah OA, Sbeih AI, Alrashdan M, Richardson AM, Moisi MD, Sbeih IA. Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report. World Neurosurg 2023; 179:204-215.e4. [PMID: 37652133 DOI: 10.1016/j.wneu.2023.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | - Mahmoud Y Asad
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Omar A Atallah
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Angela M Richardson
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Part I: oculomotor and other rare non-vestibular schwannomas (I, II, III, IV, VI). Acta Neurochir (Wien) 2022; 164:285-297. [PMID: 34755208 DOI: 10.1007/s00701-021-05048-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogeneous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the first of a three-part series describing non-vestibular schwannomas (I, II, III, IV, VI). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management of these patients is complex, and for those which are symptomatic tumours, the paradigm is shifting towards the compromise between function preservation and progression-free survival.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | | | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Pierre-Hugues Roche
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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Alhussain ZM, Alharbi SK, Farrash F. Abducens nerve schwannoma of the cavernous sinus: A case report and literature review. Surg Neurol Int 2020; 11:402. [PMID: 33365165 PMCID: PMC7749956 DOI: 10.25259/sni_362_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Schwannomas of the abducens nerve are a rare pathology and are encountered less within the cavernous sinus. We describe a case of sixth cranial nerve schwannoma, in the cavernous sinus. Case Description: A 50-year-old lady, presented with 2 years history of double vision and left facial numbness that started 6 months before presentation, found to have hyperintense lobulated mass at the left cavernous sinus extending into Meckel’s cave with bony remodeling on magnetic resonance imaging. She underwent left frontotemporal craniotomy, combined extra-intradural approach, gross total resection. She had a gradual recovery of the sixth cranial nerve function. Conclusion: Abducens nerve schwannoma of the cavernous sinus is a rare and challenging tumor. However amenable to surgical intervention with favorable neurological outcome.
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Affiliation(s)
- Zeyad M Alhussain
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shatha K Alharbi
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Nakamizo A, Matsuo S, Amano T. Abducens Nerve Schwannoma: A Case Report and Literature Review. World Neurosurg 2019; 125:49-54. [PMID: 30716483 DOI: 10.1016/j.wneu.2019.01.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Abducens nerve function seldom shows complete recovery after removal of abducens nerve schwannoma. No cases with unclear course of the abducens nerve during surgery have been reported to achieve complete recovery of nerve function. CASE DESCRIPTION We report the case of a 44-year-old woman who presented with occasional dysgeusia without abducens nerve paresis. Magnetic resonance imaging showed a solid tumor about 2 cm in diameter at the left cerebellopontine cistern. Cranial nerves except the abducens nerve appeared intact. The tumor was removed via suboccipital craniotomy. The abducens nerve was totally invisible on the surface of the tumor throughout the procedure. Only short segments of abducens nerve were identifiable at around Dorello's canal and the root exit zone. The tumor was resected by subcapsular dissection, and part of the tumor capsule was preserved as a scaffold for nerve generation, although whether any abducens nerve was included remained uncertain. Histopathologic examination confirmed World Health Organization grade I schwannoma. Postoperatively, the patient presented with complete left abducens nerve paresis and diplopia, but abducens nerve function began to improve 3 months later and had completely recovered within 16 months after surgery. CONCLUSIONS This represents the first description of abducens nerve schwannoma in which the course of the abducens nerve was intraoperatively unclear but complete recovery was achieved. In such cases, intentional subcapsular dissection may potentiate functional recovery.
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Affiliation(s)
- Akira Nakamizo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
| | - Satoshi Matsuo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Toshiyuki Amano
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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Factors Associated with Abducens Nerve Recovery in Patients Undergoing Surgical Resection of Sixth Nerve Schwannoma: A Systematic Review and Case Illustration. World Neurosurg 2017; 104:883-899. [PMID: 28465275 DOI: 10.1016/j.wneu.2017.04.146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited or no literature exists identifying factors associated with functional nerve recovery in patients undergoing resection of sixth cranial nerve (CN VI) schwannomas. METHODS A systematic review of literature was performed on CN VI schwannomas that were treated surgically. Synthesizing the findings pooled from the literature, we investigated associations of patient demographics and clinical characteristics with postsurgical CN VI functional recovery in multivariable regression models. In addition, we present the findings of an adolescent woman surgically managed for intracavernous CN VI schwannoma. Complete encasement of the cavernous segment of the internal carotid artery is unique to our case. RESULTS We synthesized data of 32 patients from 29 studies, and our index case. Overall, the mean age of the patients was 44.0 ± 16.5 years, and approximately 52% (n = 17) were female. Most tumors were left-sided (n = 18; 54.5%), with an average size of 3.46 ± 1.71 cm. The most common location was cisternal (n = 11; 33%), followed by cavernous sinus (CS) proper (n = 9; 27%), cisterocavernous (n = 8; 24%), orbital (n = 4; 12%) and caverno-orbital (n = 1; 3%). CN VI recovery was reported in less than half the cohort (n = 14; 45%). Tumor extension in the CS was significantly associated with lesser likelihood (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.98; P = 0.048) of postsurgical CN VI recovery. Although female gender (OR, 0.86; 95% CI, 0.07-10.09; P = 0.906), large tumor size (>2.5 cm) (OR, 0.45; 95% CI, 0.07-2.89; P = 0.397), and solid consistency (OR, 0.37; 95% CI, 0.03-4.19; P = 0.421) were associated with lesser odds for recovery, these were not statistically significant. Likewise, although gross total resection (OR, 6.28; 95% CI, 0.33-118.25; P = 0.220) was associated with higher odds of nerve recovery, the estimates were statistically insignificant. CONCLUSIONS CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing surgical resection for CN VI schwannoma.
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