SCHWANOMAS

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Trigeminal Schwanoma

Trigeminal Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells of the trigeminal nerve (5th cranial nerve). Trigeminal schwannomas are rare accounting for 0.07–0.3% of all intracranial tumors and 0.8%–5% of intracranial schwannomas. they usually present with facial pain, numbness and paresthesia in the distribution of one or all the divisions of the trigeminal nerve depending on the location of the tumor. MRI is the gold standard for evaluation of trigeminal schwannomas because of its multiplanar capabilities and better soft tissue contrast. It helps in diagnosis and in planning the surgical approach. Surgery is usually performed to remove schwannomas, although radiosurgery is commonly used for schwannomas, particularly if they are small.

Postoperative MRI

Residual tumour,
which was then treated
with Radiosurgery

Vestibular Nerve Schwannoma (acoustic neuromas).

Vestibular schwannomas or acoustic neuromas are the most common and typically cause hearing loss and ringing in the ears (tinnitus); as they enlarge they may also cause imbalance and incoordination as well as facial weakness. Large tumours need surgery to release the pressure on the brainstem, whilst smaller tumours could be treated with radiosurgery.

MRI

MICRO CRANIOTOMY

TUMOUR REMOVAL

INTRAOPERATIVE FACIAL NERVE MONITORING

USE OF ENDOSCOPE DURING SURGERY

COMPLETE TUMOUR REMOVAL WITH INTACT FACIAL NERVE

9thNERVE SCHWANOMA

This 50 year old lady had severe headaches, imbalance while walking, difficulty in swallowing and speaking.

The MRI brain showed a large tumour in front of the brainstem causing severe compression and dysfunction of the nerves involved in swallowing.

CT SCAN after surgery

CT SCAN after surgery

The patient did very well after surgery