Inzidenz, und postoperativer Verlauf von trigeminaler Symptomatik in Vestibularisschwannomen

Vestibular schwannoma (VS) can cause a complex symptomology of hearing loss, tinnitus, facial palsy, vertigo, but also trigeminal symptoms, such as trigeminal hypesthesia or trigeminal neuralgia. While vestibulo-cochlear symptoms have been investigated thoroughly in the past, the aim of this study is to analyze the incidence, and correlation of trigeminal symptomology with VS parameters and impact of both available treatment modality for VS: Radiosurgery (SRS) and microsurgery (SURGERY).

This is dual-center cohort study enrolling consecutive patients with sporadic VS between 2005 and 2011. Patients were identified by a prospective registry and clinical and radiographic parameters were collected retrospectively. Tumor size was classified by Koos Classification.

N=901 patients were included in this study. Only 9% of all VS patients suffered from trigeminal affection, with a higher rate of trigeminal hypesthesia (88%) and lower rate of trigeminal neuralgia (12%) within these N=81 patients. The incidence of trigeminal symptoms rose with tumor size with the highest rate in Koos IV with 28% trigeminal hypesthesia and 3% trigeminal neuralgia. Postinterventional relief of trigeminal symptoms was significantly higher in SURGERY at 97%, compared to SRS with 43% (p<0.001). The rate of new-onset trigeminal affection was the highest in large VS (Koos III-IV) treated with SRS at 3% and 6% respectively. This was significantly lower in SURGERY-treated VS with 1% (Koos III) and 3% in Koos IV.

Trigeminal hypesthesia, especially trigeminal neuralgia is very rare in VS. The incidence of trigeminal symptomatics (affection and neuralgia) correlates with larger tumor size. SURGERY is an effective therapy for trigeminal affection in VS yields in less therapy-related new onset—trigeminal affection compared to SRS.