Neurilemmoma (Schwannoma) Treatment & Management

Updated: Oct 08, 2020
  • Author: Ian D Dickey, MD, FRCSC, LMCC; Chief Editor: Harris Gellman, MD  more...
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Treatment

Medical Therapy

Neurilemmomas (neurilemomas; also referred to as schwannomas) can cause a functional deficit because of local pressure on the nerve of origin. Malignant degeneration, which is extremely rare, was described by Yousem et al in 1985. [11] Primary malignant tumors of this cell type do exist, but they are histologically distinct from neurilemmomas. In an unusual case in which resection would lead to a significant functional deficit, these benign lesions can be merely observed.

In a study assessing trends in management of unilateral vestibular schwannoma at Johns Hopkins University from 1997 through 2007, Tan et al noted an increase in cases observed with follow-up scanning (from 10.5% to 28.0%) and recommended for radiation (from 0% to 4.0%), along with a decrease in surgical cases (from 89.5% to 68.0%). [12] The increased frequency of observation was significant even after age, hearing status, and tumor size were controlled for. Tan et al concluded that this trend implied changes in both provider philosophy and patient expectations.

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Surgical Therapy

Like most benign tumors, neurilemmomas respond well to local resection. On inspection, the nerve is usually splayed out over the lesion. The lesion is excised marginally, and the nerve fibers are spared. Interlesional resection is warranted when complete resection would result in permanent neurologic deficit. Local control is usually excellent. [13, 14, 15, 16, 17]

Effective use of sterotactic radiosurgery (SRS) for these types of lesions has been reported. [18, 19, 20, 21, 22, 23]

Kano et al evaluated tumor control and hearing preservation relating to tumor volume, imaging characteristics, and nerve and cochlear radiation dose after SRS with a Gamma Knife (Elekta, Stockholm, Sweden) in patients with acoustic neuroma. [4] At a median of 20 months, no patients required further treatment. Serviceable hearing was preserved in 71% of all patients and in 89% of those with Gardner-Robertson (GR) class I hearing. Patients who received a cochlear radiation dose lower than 4.2 Gy had significantly better hearing preservation of the same GR class, and all patients younger than 60 years who received a dose lower than 4.2 Gy retained serviceable hearing at 2 years.

Endoscopic approaches have been used for schwannomas of the head and neck. [24, 25]

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Complications

The most common complication of surgical treatment of neurilemmoma is initial neurapraxia; however, this neurologic deficit can be permanent, depending on the resection of neural tissue. Generally, patients tolerate resection well, with complete and rapid relief of symptoms.

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