Clinical characteristics, surgical approaches, and outcomes of pediatric trigeminal schwannomas: a case series and literature comparison.
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BACKGROUND: Trigeminal schwannomas (TS) are rare intracranial tumors and are exceptionally uncommon in the pediatric population. Existing literature is limited to isolated case reports and small series, leaving uncertainty regarding optimal surgical strategies and outcomes in children. OBJECTIVE: To analyze the clinical characteristics, surgical approaches, and outcomes of pediatric trigeminal schwannomas treated at a single tertiary care center and to review relevant literature. METHODS: A retrospective analysis was performed of all patients younger than 18 years with histologically confirmed TS who underwent surgical treatment between 2009 and 2024. Clinical presentation, radiological features, tumor classification according to Yoshida and Kawase, surgical approach, extent of resection, postoperative complications, and outcomes were reviewed. Gross total resection (GTR) was defined as complete intraoperative excision with no residual tumor on postoperative MRI. Patients were followed clinically and radiologically to assess neurological recovery and tumor recurrence. RESULTS: Fourteen patients were included, with a mean age of 10.2 years. Headache was the most common presenting symptom (85.7%), followed by trigeminal sensory dysfunction (50%). Dumbbell-shaped tumors were predominant (85.7%). Tailored skull base approaches-including subtemporal interdural, retrosigmoid, transpetrosal, and combined single-stage approaches-were employed based on tumor location and extent. GTR was achieved in all patients. Postoperative worsening of trigeminal nerve function was common but showed improvement in the majority during follow-up. No mortality or tumor recurrence was observed. CONCLUSION: Pediatric TS frequently presents late with large, multicompartmental tumors. Gross total resection using individualized skull base approaches is feasible and provides excellent tumor control with acceptable morbidity. Careful surgical planning is critical to maximize resection while preserving neurological function in this challenging patient population.