Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas

Abstract

The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5–10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.

Keywords:

• schwannoma
• head and neck
• cranial nerves
• non-vestibular
• skull base

Acknowledgment

This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

Disclosure

Johannes A Langendijk reports non-financial support from RaySearch, grants, personal fees, and consultancy fees paid to UMCG Research BV from IBA, and that the Department of Radiation Oncology has research collaboration with IBA, RaySearch, Elekta, Siemens, and VisionRT, outside the submitted work. The authors report no conflicts of interest in this work.