Mediterr J Otol 2006:2(2):93-97

Surgical Treatment of Cerebellopontine Angle Trigeminal Schwannoma Via a Retrosigmoid Intradural Approach: A Case Report

Christian Dubreuil, Cédric Porret

Otoneurosurgery Department, Centre Hospitalier Lyon-Sud, Pierre Bénite

OBJECTIVES: Schwannoma of the trigeminal nerve is a rare entity: those located in the posterior fossa account for 20% of all cases. The aims of this report are to describe a case of cerebellopontine angle schwannoma and to define the clinically common presentation, the medical imaging needed, and the surgical procedure used to treat this lesion.

MATERIALS AND METHODS: We report the clinical features, neuroradiologic imaging, and management of a case of trigeminal schwannoma located in the cerebellopontine angle, arising from the sensitive root of the trigeminal nerve, and managed at the Lyon Department of Otoneurosurgery at the Centre Hospitalier Lyon-Sud in Pierre Bénite, France.

RESULTS: This trigeminal schwannoma developed in the cerebellopontine angle without extension into the Meckel’s cave. Our patient presented with facial pain and facial palsy, and medical imaging revealed a cerebellopontine mass. Surgery, using a retrosigmoid intradural route, was performed, and a diagnosis of trigeminal schwannoma from the roots of the sensitive part of the nerve was made. The lesion was resected, and the patient left the hospital 7 days after surgery. This article discusses the differential diagnosis of cerebellopontine angle tumors. It also shows the different surgical approaches to removing a trigeminal schwannoma, according to its location and its volume.

CONCLUSION: The retrosigmoid intradural approach is an effective and safe procedure, with low morbidity, for removing cerebellopontine angle trigeminal schwannomas—even in cases of large tumors—when the Meckel’s cave is not invaded. It is important to define the extent of the lesion site to determine the most appropriate surgical technique.