1/100. Primary lymphoma of Meckel's cave mimicking trigeminal schwannoma: case report.OBJECTIVE AND IMPORTANCE: We report the first case of primary lymphoma of Meckel's cave. The ability of a lymphoma to mimic a trigeminal schwannoma, both clinically and radiographically, resulted in misdiagnosis and flawed surgical strategy. We discuss the characteristics of a Meckel's cave lymphoma on magnetic resonance images, the predisposing medical conditions that should cause the neurosurgeon to add lymphoma to the normal differential diagnosis, and appropriate management strategies. CLINICAL PRESENTATION: A 40-year-old African-American woman presented with a 5-month history of progressive facial numbness and pain in all three divisions of the left trigeminal nerve. magnetic resonance imaging revealed a mass in the left side of Meckel's cave, with extension into the lateral compartment of the cavernous sinus, without encasement of the internal carotid artery, through the foramen rotundum into the posterior aspect of the maxillary sinus, and through the foramen ovale into the pterygopalatine fossa. The diagnosis, based on clinical history and radiographic imaging, was schwannoma of Meckel's cave. The patient had a history of systemic lupus erythematosus that had been treated with intermittent steroid therapy. INTERVENTION: The surgical approach selected was a frontotemporal craniotomy with orbitozygomatic osteotomy and anterior petrosectomy. The lesion was totally excised, although the gross intraoperative appearance of the lesion was inconsistent with the preoperative diagnosis, and the pathological examination was unable to establish a histological diagnosis on the basis of frozen sections. Histological diagnosis was confirmed on permanent section after surgery as B-cell lymphoma. Evaluation for other primary sites produced negative results. The patient was then treated with cyclophosphamide (Cytotoxan; Bristol-Myers Oncology, Princeton, NJ), doxorubicin (Adriamycin; Pharmacia & Upjohn, Kalamazoo, MI), vincristine, and prednisone chemotherapy every 3 weeks for six cycles and then by radiation therapy to the affected area. CONCLUSION: The diagnosis of lymphoma should be considered for lesions affecting Meckel's cave in high-risk immunocompromised patients. The presence of an apparent dural tail in an otherwise typical schwannoma is the distinguishing characteristic of a lymphoma. The absence of hyperostosis helps differentiate it from a meningioma. At this point, the preferred surgical strategy is biopsy for diagnosis and then radiotherapy and chemotherapy rather than major cranial base surgery for total resection.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
2/100. A trigeminal neurinoma involving the lacrimal nerve: case report.An isolated neurinoma involving the entire length of the lacrimal nerve is reported. The tumour was large and involved both the intracranial cavernous sinus, as well as the extracranial intraorbital part of the nerve. The patient, a 45-year-old housewife had a painless progressive proptosis associated with marginally decreased lacrimation of the affected eye. There was no evidence of neurofibromatosis.- - - - - - - - - - ranking = 0.5keywords = sinus (Clic here for more details about this article) |
3/100. sphenoid sinus schwannoma treated by endoscopic excision.Schwannomas, arising from the schwann cells of the nerve sheath, occur very rarely in the sino-nasal tract and histological diagnosis can, sometimes, be difficult. We describe a case of schwannoma of the sphenoidal sinus occurring in a 71-year-old man, who underwent complete excision of the tumour endoscopically. To our knowledge, this is the third case of sphenoid sinus schwannoma reported in the English literature.- - - - - - - - - - ranking = 3keywords = sinus (Clic here for more details about this article) |
4/100. Hypoglossal neurinoma--two case reports.Two patients presented with hypoglossal neurinoma extending both intra- and extracranially. A 63-year-old male presented with right trigeminal neuralgia and hypoglossal nerve paresis. The intracranial part of the tumor was removed totally via a suboccipital craniectomy. Over-coagulation of the venous collaterals, particularly the emissary veins, resulted in dural venous sinus thrombosis and cerebellar infarction. Unfortunately this patient died. A 48-year-old male presented with pareses of the VII, IX, X, XI, and XII cranial nerves and cerebellar sign. The tumor extended both extra- and intracranially, and was completely removed by opening the hypoglossal canal and the jugular foramen without over-coagulation of the venous collaterals. Preservation of the venous collaterals is very important for the prevention of postoperative venous complications.- - - - - - - - - - ranking = 0.5keywords = sinus (Clic here for more details about this article) |
5/100. A case of schwannoma on the nasal septum.We present a case of nasal septal schwannoma. The patient was a 62-year-old female complaining of bilateral nasal obstruction. Anterior rhinoscopy revealed a smooth-surfaced mass arising from the nasal septum in both nasal cavities. Computed tomography scan showed a mass with enhancement in the two nasal cavities and the ethmoid sinuses, and this mass extended to the skull base. Lateral rhinotomy was performed under general anesthesia. The tumor arose from the nasal septum, occupied both nasal cavities, and extended to the anterior ethmoid sinuses. It was encapsulated and could be totally removed en bloc. Pathological examination of the excised specimen showed that it was an Antoni type A schwannoma. The tumor cells were immunoreactive for S-100 protein. The patient is doing well with no evidence of recurrence.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
6/100. Neurilemmomas of the paranasal sinuses.Within the head and neck region, neurilemmomas are rarely found in the nasal cavity or paranasal sinuses. A 70-year-old man presented with complaints of left-sided epiphora, rhinorrhea, epistaxis, and transient diplopia. Nasal endoscopy showed a large necrotic mass filling the left middle meatus. A computed tomography scan showed a large left ethmoid mass, with erosion of the medial wall of the orbit and the anterior cranial base. Multiple biopsies were nondiagnostic. Complete excision of the tumor was performed with endoscopic techniques. Small dural defects were repaired with a middle turbinate mucosal flap. Postoperatively, the patient was treated with nasal packing and a lumbar spinal drain. Final pathology showed a benign neurilemmoma. There has been no evidence of recurrence or cerebrospinal fluid leakage in follow-up. A review of the literature shows a similar presentation of patients with neurilemmomas of the paranasal sinuses. Bony destruction and intracranial extension is viewed. Lack of encapsulation and locally destructive growth in an otherwise histologically typical neurilemmoma should not suggest malignant potential. Many benign tumors of the paranasal sinuses with bone destruction may be removed by using endoscopic techniques.- - - - - - - - - - ranking = 188.77495121212keywords = paranasal sinus, paranasal, sinus (Clic here for more details about this article) |
7/100. Intracavernous schwannoma of the abducens nerve: a review of the clinical features, radiology and pathology of an unusual case.We report a case of an intracavernous abducens nerve schwannoma presenting in a 19 year old male of Mediterranean origin. This is only the second report of an abducens nerve schwannoma located entirely within the cavernous sinus. The lesion resulted in a progressive diplopia and focal abducens palsy. The clinical, radiological and pathological features are presented. A literature search has identified only four other abducens nerve schwannomas arising completely or partly within the cavernous sinus. We review these cases and aspects of other ocular cranial nerve schwannomas.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
8/100. Extended frontal approach with bilateral orbitofrontoethmoidal osteotomies for removal of a giant extracranial schwannoma in the nasopharynx, sphenoid sinus, and parapharyngeal space.BACKGROUND: Although parapharyngeal schwannomas are not uncommon, schwannomas of the nasopharynx and paranasal sinuses are rare lesions. In the absence of intracranial extension, they are usually removed with transantral, lateral rhinotomy or more complex transfacial approaches. CASE DESCRIPTION: We report a 24-year-old patient with a giant benign schwannoma involving the superior parapharyngeal space, pterygopalatine fossa, nasopharynx, and sphenoid sinus with erosion into the clivus that was removed with an extended frontal approach including bilateral orbitofrontoethmoidal osteotomies. CONCLUSION: The advantages of the extended subfrontal over more standard transfacial approaches for lesions in this location include the early dissection of critical neural structures, preserving cosmetics and facilitating management of an inadvertent cerebrospinal fluid leak.- - - - - - - - - - ranking = 29.46785017316keywords = paranasal sinus, paranasal, sinus (Clic here for more details about this article) |
9/100. A case of neuroendocrine oncogenic osteomalacia associated with a PHEX and fibroblast growth factor-23 expressing sinusidal malignant schwannoma.Oncogenic osteomalacia is a rare paraneoplastic syndrome that is characterized biochemically by hypophosphatemia and low plasma 1,25-dihydroxyvitamin D3, and clinically by osteomalacia, pseudofractures, bone pain, fatigue, and muscle weakness. We present a patient with a malignant schwannoma as the underlying cause of this disorder. A permanent cell line (HMS-97) derived from this tumor showed evidence of neuroendocrine differentiation by immunohistochemistry and of neurosecretory activity by electron microscopy. The cell line did express PHEX (phosphate-regulating gene with homologies to endopeptidases located on the X-chromosome) and FGF-23 (fibroblast growth factor-23) transcripts on northern hybridization; however, none of the known mutations from the related mendelian disorders of X-linked hypophosphatemic rickets or autosomal-dominant hypophosphatemic rickets could be detected. Tumor cell (HMS-97)-derived conditioned medium did not inhibit phosphate transport in a standard opossum kidney cell assay and in animal experiments. The medium also showed no PTH1- or PTH2-receptor-stimulating bioactivity. HMS-97 cells might be useful for further studies that aim to determine the genetic mechanism that leads to the observed PHEX and FGF-23 expression, both of which might have a direct role in the pathogenesis of oncogenic osteomalacia. In addition, these cells might be a useful tool for the investigation of neuroendocrine Schwann cell function and autoimmune peripheral nerve disease.- - - - - - - - - - ranking = 2keywords = sinus (Clic here for more details about this article) |
10/100. Nasal schwannoma: a case report and clinicopathologic analysis.According to the literature, half of the schwannoma cases occur in the head and neck areas and only less than 4% occur in the sinonasal tract. In this case, a 39-year-old male patient, with a-year-long progressive left side nasal obstruction and purulent rhinorrhea, is presented. The CT reveals a mass filling the left nasal cavity and nasopharyngeal space, with bony erosion of the inferior turbinate and medial maxillary bone. During surgical intervention, the mass is found to originate from the medial side of the left middle turbinate with maxillary sinusitis and inferior turbinate atrophy. The pathological examination reveals a noncapsulated tumor with palisading cellular arrangement and high cellular density. The pathological findings and nervous origin of the tumor are discussed after an extensive review of the literature.- - - - - - - - - - ranking = 0.5keywords = sinus (Clic here for more details about this article) |
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