Schwannoma tumours are slow-growing tumours that grow from inside the nerve sheath. Unlike other neural tumours that arise from the nerve sheath, schwannomas form from Schwann cells of the individual nerve fibres. While most schwannomas occur randomly, specific conditions such as von Recklinghausen's disease, sometimes called neurofibromatosis (NF), can cause schwannomas to grow throughout the body. Physical examination combined with body scanning can help doctors determine if NF is present. Treatment for schwannoma tumours varies depending on the size and location of the tumour, symptoms the tumour is causing and the health of the patient.
Schwannomas are predominantly benign tumours. In rare cases, the tumours can become malignant. The tumours can grow anywhere throughout the nervous system. The most common places for schwannoma tumours are in the brain, throughout the trunk, and at the flexes of the peripheral nerves. Treatments are dependent on the location and whether the tumour is benign or malignant.
Surgical intervention is the most common treatment for schwannomas. Because schwannomas are nerve, or neural, tumours, a neurosurgeon performs these surgeries. It is important to have a skilled neurosurgeon in order to have the best possible outcome. When dealing with schwannomas, nerve fibres are involved, which can mean lifelong problems if they are damaged or cut. Neurosurgeons also have sub-specialities or focus areas that they regularly treat. Finding a neurosurgeon with an area of focus matching the location of the tumour further reduces nerve damage risks. Neurosurgeon-oncologists deal with malignant neural tumours, so patients with malignant schwannomas benefit greatly from treatment from this speciality. Post-surgery, patients often have nerve dysfunction such as numbness, tingling, and pins and needles sensations. Sometimes surgery causes nerve trauma, which leads to temporary nerve pain and sensitivity. If sacrifice of an individual fibre occurs, numbness can be permanent.
Gamma Knife Surgery
If a schwannoma is particularly large, the neurosurgeon may choose to use Gamma Knife or reflected solar radiation (FSR) to shrink the tumour. This can be a primary treatment or can shrink the tumour prior to surgery. Smaller tumours are easier to remove and lower the risk of significant nerve damage.
Close supervision by a doctor is sometimes the best choice. If the tumour is not causing any symptoms, has no signs of malignancy and the patient and doctor are comfortable with leaving it in for the time being, the tumour is carefully monitored periodically to ensure that it is not a danger to the patient. Most often, the patient has regular checkups including magnetic resonance imaging (MRI) scans to measure growth and tumour features. The doctor looks over these scans, and combined with any new symptoms determines whether surgical intervention is necessary.
People with benign schwannomas that are in poor general health may not be candidates for surgery. In these cases, radiation may shrink the tumour and reduce the symptoms associated with it. Doctors use close supervision of the tumour to make sure it doesn't undergo any malignant transformation.
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