From the Guidelines
Schwannoma, also known as neurofibroma or neurilemmoma, is a benign tumor that develops from Schwann cells, which form the protective sheath around peripheral nerves, and its management depends on the location, symptoms, and tumor size, with treatment options including observation, surgical resection, fractionated radiotherapy, and radiosurgery, as recommended by the European Association of Neuro-Oncology 1. Management of schwannomas involves:
- Observation: For small, asymptomatic tumors, regular monitoring with MRI scans every 1-2 years is often recommended.
- Surgery: If the tumor is causing pain, neurological deficits, or growing rapidly, surgical removal is the primary treatment, with the goal of complete resection while preserving nerve function.
- Radiation therapy: In cases where surgery is risky or incomplete, stereotactic radiosurgery may be used to control tumor growth, with a recent study showing that SRS has at least equivalent rates of tumor control and hearing preservation as compared to microsurgical resection, with better facial nerve preservation 1. No specific medications are used to treat schwannomas directly, but pain management may include:
- NSAIDs like ibuprofen (400-800 mg every 6-8 hours)
- Gabapentin (300-600 mg three times daily) for nerve pain It is essential to note that the choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center, and that stereotactic radiosurgery is a noninvasive treatment with high rates of tumor control and hearing preservation, making it a viable option for patients with schwannomas, especially those with intracanalicular vestibular schwannomas 1.
From the Research
Definition and Characteristics of Schwannoma
- Schwannomas are benign nerve sheath tumors that arise from Schwann cells, which are responsible for producing the myelin sheath that surrounds nerves 2.
- They are typically slow-growing and can occur in various locations in the body, including the lumbar region of the spine 2.
- Schwannomas can cause significant symptoms and require appropriate diagnosis and management 2.
Types and Locations of Schwannoma
- Vestibular schwannomas are a type of schwannoma that occurs in the vestibular nerve, which is responsible for balance and hearing 3, 4, 5.
- Orbital schwannomas are a rare type of schwannoma that occurs in the orbit, which is the bony cavity that contains the eye 6.
- Lumbar schwannomas are a type of schwannoma that occurs in the lumbar region of the spine 2.
Management and Treatment of Schwannoma
- Microsurgery is the preferred treatment for schwannomas, and endoscopic microsurgery is the most promising technique 2.
- Conservative management may be a desirable alternative for some patients, especially those with small tumors or minimal symptoms 3, 4, 6, 5.
- Regular follow-up with interval scanning is mandatory in all patients with schwannomas, regardless of the management approach 4, 6, 5.