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

Authors Suárez C, López F, Mendenhall WM, Andreasen S, Mikkelsen LH, Langendijk JA, Bondi S, Rodrigo JP, Bäck L, Mäkitie AA, Fernández-Alvarez V, Coca-Pelaz A, Smee R, Rinaldo A, Ferlito A

Received 18 October 2020

Accepted for publication 30 December 2020

Published 18 January 2021 Volume 2021:13 Pages 463—478


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Harikrishna Nakshatri

Carlos Suárez,1,2 Fernando López,1– 3 William M Mendenhall,4 Simon Andreasen5– 7†, Lauge Hjorth Mikkelsen,7 Johannes A Langendijk,8 Stefano Bondi,9 Juan P Rodrigo,1– 3 Leif Bäck,10 Antti A Mäkitie,10– 12 Verónica Fernández-Alvarez,13 Andrés Coca-Pelaz,1– 3 Robert Smee,14 Alessandra Rinaldo,15 Alfio Ferlito16

1Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; 2Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain; 3Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; 4Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA; 5Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark; 6Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; 7Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 8Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 9Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy; 10Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; 11Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; 12Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; 13Vascular Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain; 14Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia; 15University of Udine School of Medicine, Udine, Italy; 16International Head and Neck Scientific Group, Padua, Italy

†Simon Andreasen passed away on February 28, 2020

Correspondence: Carlos Suárez
Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Avenida de Roma s/n, Oviedo 33011, Spain
Fernando López
Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, Oviedo 33011, Spain

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

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