Surgical Treatment Options for Schwannoma: Excision and Nerve Preservation

A schwannoma is an atypical, neurogenic tumor made up of Schwann cells that’s often treated through Schwannoma surgery, also known as tumor enucleation. Tumor enucleation is the most preferred procedure to treat a schwannoma since it preserves the function of the original nerve. The goal of Schwannoma surgery is to achieve complete resection of the tumor while preserving nerve function. Understanding schwannoma formation, detection and treatment is important for those considering Schwannoma surgery. 

What is a schwannoma?

A Schwannoma is a rare type of tumor that forms in the nervous system and is sometimes called neurinoma or neurilemmoma. The development of a Schwannoma most often occurs in the extracranial head and neck region and tends to be located in the parapharyngeal space. Schwannomas originate from cells called Schwann cells, which protect and support the nerve cells of the nervous system. These tumors are often benign, meaning they’re not cancerous. However, in rare cases, these tumors do become cancerous.

A schwannoma can be a brain tumor, but not always; it can form in your brain or head, but can also originate elsewhere in the body. This is due to Schwann cells and their role in the development of schwannomas. Schwann cells exist in the peripheral nervous system, which consists of nerves in the brain and throughout the body. The most common type of schwannoma, however, is considered a brain tumor and is referred to as a vestibular schwannoma.

People diagnosed with a schwannoma can have symptoms, although some don’t. Symptoms of schwannomas range and can differ depending on where the tumor is in the body. Symptoms of schwannomas include hearing loss or ringing in the ears, dizziness, pain, facial paralysis, trouble swallowing, trouble moving the eye, and numbness or tingling. 

Schwannoma formation and detection

Schwannomas develop specifically in the cranial sympathetic or peripheral nerves and are detected through preoperative imaging, such as a computed tomography or magnetic resonance imaging. Through this detection process, the schwannoma size, location and origin is determined. 

It’s common for patients to have a schwannoma for several years before getting diagnosed, since they grow slowly and can often cause no symptoms at first. However, when they are diagnosed, it’s important for patients to understand the nuances of Schwannoma surgery and nerve preservation. 

Schwannoma surgery and nerve preservation | Nerve-sparing Schwannoma removal

For the treatment of a schwannoma, surgical resection—or Schwannoma surgery—is the only curative treatment. Radiation treatment is sometimes recommended, as it will slow down or in some cases stop further tumor growth. 

The key issue with schwannoma surgery is to safely remove the tumor completely, when possible, while preserving the nerve to which it is attached. Schwannomas can occur on any nerve in the body, including the cranial nerves that are located within the skull. More commonly the tumor arises from the 8th cranial nerve (vestibular nerve), but may arise from other cranial nerves as well.

The challenges of Schwannoma surgery and nerve preservation

As advancements in microsurgical techniques and intraoperative monitoring technologies have advanced, the gross total resection (GTR) of these tumors have become the ideal goal. However, there is greater risk associated with GTR, including the chances of cranial nerve morbidities and permanent facial nerve injury.  

Although tumor size tends to be one of the main predictors of facial nerve preservation, studies reported upwards of an 80 percent chance of good to excellent facial nerve preservation in a specific subset of patients. What increases the chances of anatomical and physiological preservation of the facial nerve comes down to a few things, including a thorough understanding of CP angle anatomy, top-tier microsurgical techniques, and intraoperative monitoring. 

Schwannoma removal in New Jersey

For more than 25 years, the experienced physician team at New Jersey Brain and Spine has delivered highly-skilled and compassionate care to more than 40,000 patients with complex brain, spine and neurological conditions. Please contact us today to decide if we are the right option for your care and treatment.

We also offer an expert second opinion service should you wish to discuss your treatment options. For more information, or to request a second opinion, reach out to us immediately by calling 201-342-2550 or emailing us at secondopinion@NJBrainSpine.com