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Abstract
Introduction. Trigeminal neuroma is a tumor with a variable natural history. With supra- and subtentorial spread, these neoplasms cause difficulties in the choice of treatment due to the risk of disability after surgery or progression after radiation.
Aim. To evaluate the results of combined treatment of patients with trigeminal neuromas with concurrent supra- and subtentorial growth.
Materials and Methods. The study included 23 patients with trigeminal neuromas with simultaneous tumor growth in several cranial fossae, who underwent combined treatment at the N.N. Burdenko National Medical Research Center of Neurosurgery from 2010 to 2022. All patients underwent tumor removal surgery as the first stage, and radiation treatment as the second stage. The average time between surgery and radiotherapy was 14.1 months.
Results. The combined treatment contributed to the improvement of cerebellar disorders (p-value = 0.008), the disappearance of nystagmus (p-value < 0.001), but also, in turn, an increase in the insufficiency of the sensitive portion of the trigeminal nerve (p-value = 0.018), especially hypoesthesia (p-value = 0.002), the appearance of neuropathic pain (p-value = 0.015) and paresthesia in the face (p-value < 0.001), as well as dysfunction of the motor portion of the trigeminal nerve (p-value — 0.012).
Comparing activity levels on the Karnofsky scale before surgery, after surgery and 6 months after radiation treatment, there was a decrease in activity levels immediately after tumor removal in 60 % of cases, followed by an increase in activity levels in the long term in 65 % of cases (p-value < 0.001).
The median progression-free survival in this group of patients was 106 months. 3-year progression-free survival — 0.938.
Conclusion. The increase in trigeminal nerve dysfunction after treatment is quite natural and is determined by the nature of the tumor. The improvement in Karnofsky activity scale in the long term (more than 6 months after radiation treatment) and the high 3-year progression-free survival result allow us to consider combined treatment as the method of choice in the treatment of patients with supra- and subtentorial trigeminal neuromas.
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