• Dia R Halalmeh, Mahmoud Y Asad, Omar A Atallah, Asil I Sbeih, Mohammad Alrashdan, Angela M Richardson, Marc D Moisi, and Ibrahim A Sbeih.
• Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA. Electronic address: deaa_h1@yahoo.com.
• World Neurosurg. 2023 Nov 1; 179: 204215.e4204-215.e4.

BackgroundAbducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined.ObjectiveTo characterize clinical features of AN schwannomas and predictors of surgical outcomes.MethodsPRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes.ResultsA total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040).ConclusionsAN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.Copyright © 2023 Elsevier Inc. All rights reserved.

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