1.Treatment Strategies Of Middle Skull Base Trigeminal Schwannoma With Intra-extracranial Extension 2.Classification And Treatment Strategies Of Middle Skull Base Tumor With Intra-extracranial Extension

Objective To investigate the treatment strategies of middle skull base trigeminal schwannoma with intra-extracranial extension.Methods By retrospectively reviewed 18 patients with middle skull base trigeminal schwannoma with intra-extracranial extension verified by surgery and pathology between June 2006 and July 2016,the author analyzed the characteristics of clinical manifestations,imaging features,treatment and follow-up data.Results Total tumor excision was achieved in all of the patients in a single stage.Endoscopic sinus access was performed in 2 cases,maxillary approach in 12,and extradural approach in the middle skull base in 4 cases.New cranial nerve dysfunction occurred in 2 cases,Cerebrospinal fluid leakage occurred in 2 cases,decompression epidural hematoma occurred in 1 case,blood oozing from the incision occurred in 3 cases,intracranial infection occurred in 2 cases,no osteonecrosis of the maxilla occurred in all cases.All the complications were cured.The diagnosis of schwannoma were verified pathologically in all cases,Benign tumors was identified in 14 cases,malignant in 4 cases,and malignant rate was 22.2%(4/18).Radiotherapy was performed in all of the 4 patients with malignant tumor after surgery.17 cases had been averagely followed up for 31.4 months,1 patient with malignant tumor was lost.1 patient with malignant tumor had died.2 cases of malignant tumor recurred and were excised again.No recurrence was observed in all patients with benign tumor.Conclusions The middle skull base trigeminal schwannoma with intra-extracranial extension are often large tumor volume.It is suggested that an intracranial tumor predominantly in the middle fossa with extracranial extension can be resected via an middle cranial fossa extradural approach;An predominantly extracranial tumor with small extension in the middle fossa can be resected via an Maxillary swing approach or endoscopic skull base surgery.This kind of tumor should be radically resected,due to the higher malignant proportion than that of other schwannoma.The malignant tumor patients need radiotherapy after surgery to reduce tumor recurrence.Objective To investigate the classification and treatment strategies of middle skull base tumor with intra-extracranial extension.Methods By retrospectively reviewed 34 patients with middle skull base tumor with intra-extracranial extension verified by surgery and pathology between June 2006 and February 2017,the author analyzed the characteristics of clinical manifestations,imaging features,treatment and follow-up data.Results Of the benign tumors,1 cases were resected by stages and all the other ones were totally resected in a single stage.In the malignant tumors,2 cases were subtotal resection,and the other ones were totally resected in a single stage.21 cases of type A tumors,10 cases of type B tumors and 3 cases of type C tumors.New cranial nerve dysfunction occurred in 3 cases,Cerebrospinal fluid leakage occurred in 3 cases,decompression epidural hematoma occurred in 3 cases,blood oozing from the incision occurred in 3 cases,intracranial infection occurred in 3 cases,Pulmonary infection occurred in 1 case.All the complications were cured.The pathological diagnosis showed benign tumors were identified in 20 cases,malignant in 14 cases,and malignant rate were 41.2%(14/34).Radiotherapy and chemotherapy were performed in all of the 14 patients with malignant tumor after surgery.32 cases had been averagely followed up for 32.8 months,2 patient with malignant tumor was lost.3 patient with malignant tumor had died.5 cases of malignant tumor recurred and were excised again.No recurrence was observed in all patients with benign tumor.Conclusions The middle skull base tumor with intra-extracranial extension can be divided into 3 types:type A,most of the tumor located in the infratemporal fossa or(and)the pterygopalatine fossa,a small part extend to the middle cranial fossa;type B,most of the tumor located in the middle cranial fossa,a small part extend to the infratemporal fossa or(and)the pterygopalatine fossa;type C,both the intracranial part and the extracranial part of the tumor are very large.This kind of tumor should be radically resected,due to the higher malignant rate.It is suggested that an intracranial tumor predominantly in the middle fossa with extracranial extension can be resected via an middle cranial fossa extradural approach;An predominantly extracranial tumor with small extension in the middle fossa can be resected via an Maxillary swing approach or endoscopic skull base surgery.The malignant tumor patients need radiotherapy and chemotherapy after surgery to reduce tumor recurrence.