Multimodality Management of Trigeminal Schwannomas and Quality of Life Outcomes-A Single Institution Experience
Notice bibliographique
Résumé
Background: Trigeminal schwannomas are the second most common among intracranial schwannomas. These can arise from anywhere between the root and the distal extracranial branches of the trigeminal nerve. Clinical presentation depends on location and size, including but not limited to facial hypoesthesia or pain, headaches, dizziness, ataxia, and diplopia. Literature is strikingly scant discussing the natural history of these lesions, while the treatment goals are heavily dependent on tumor presentation. Management decisions have to be individualized to each tumor and each patient, while attempting to maximize the quality of life. We present a unique look at single institution management of these lesions, whether by surgery, radiation, or by serial imaging, report on the quality of life of patients diagnosed with trigeminal schwannomas. Methods: Between 2001 and 2015, 28 patients (64.3% female) with trigeminal schwannomas were diagnosed and managed with trigeminal schwannomas at Vancouver General Hospital. We analyzed the clinical presentation, surgical results, resection rates, patient quality of life, and complications. To complete the evaluation, we prospectively collected SF-36 Quality of Life assessments from patients and compared post-treatment quality of life assessments with those completed by patients at the time of the initial clinic visit. Results: We were able to identify 12 patients treated with a craniotomy and surgical resection, 6 who had radiation treatment, while 10 patients were followed by observation. Mean age of study cohort was 52.1 years (range 23–82 years), and most patients presented with facial hypoesthesia (53.6%) and headaches (39.3%) while 32.1% were incidental. There were no major differences in patient demographics between three groups. Patients offered surgery had larger lesions (mean diameter 3.4 cm) when compared with those that were irradiated or observed, and were more likely to have extracranial extension. There were no neurologic or medical complications of surgical treatment, while 66.7% patients had worsening of symptoms following radiation treatment requiring steroid use. Overall patient quality of life perception improved in the cohort following surgery (ΔSF-36 +8.4), while those patients that underwent radiation or were observed started with an overall higher SF-36 score (66.1 and 61.1 respectively). Conclusions: The treatment goals of trigeminal schwannomas focus on improvement in neurologic symptoms, relief of mass effect, and preservation of cranial nerve function. These must be balanced against preservation of patient quality of life, which we demonstrate only marginally improves with treatment interventions. Individualization of management strategies on a case by case bases should be conceptualized by a dedicated skull base team. Where possible, a complete surgical resection should be the treatment of choice but advancements in radiosurgical techniques have opened up possibilities for primary management of smaller lesions as well as for postoperative residuals or recurrences.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».