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Xu T, Liu Y, Li S, Zheng L. Pre-operative embolization and excision of vagal schwannoma with rich vascular supply: A case report and literature review. Medicine (Baltimore) 2022; 101:e28760. [PMID: 35089254 PMCID: PMC8797582 DOI: 10.1097/md.0000000000028760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Schwannomas are benign tumors wrapped in the nerve sheath and can originate from the myelin sheath of the cranial nerve. In previous literature reports, most of the tumors were solid tumors, which can be removed only by surgery. This case report describes a unique case of vagal schwannoma, which, unlike previous cases, involves a dominant arterial supply, and discusses the pre-operative evaluation, relevant radiographic findings, and surgical process of the case in detail. PATIENT CONCERNS A 31-year-old woman sought treatment for pain in the left side of the neck when turning her head. A mass on the left side of the neck was found on enhanced computed tomography with a maximum diameter of 6.8 cm, along with multiple tortuous, thickened vascular shadows, and pressure on the left pharyngeal cavity. DIAGNOSIS The pathological results showed schwannoma. INTERVENTIONS Considering the unusual size of the tumor and thickened blood vessels revealed by pre-operative computed tomography, general anesthesia and biopsy were conducted first to confirm the diagnosis. Excessive bleeding occurred during the process; thus, the tumor was only partially removed before the wound closed after hemostasis. Digital subtraction angiography indicated that the tumor was supplied by multiple arteries, and the tumor was removed by pre-operative embolization plus intra-operative removal. OUTCOMES Combined with embolization and surgical resection, the tumor was completely removed, the nerve was partially preserved, and the patient had postoperative hoarseness. LESSON The present case indicates the possibility of vascularly supplied vagal schwannoma; thus, it is necessary to conduct pre-operative digital subtraction angiography.
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Landry AP, Ye VC, Vaughan KA, Drake JM, Dirks PB, Cusimano MD. Pediatric multicompartmental trigeminal schwannoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2171. [PMID: 35855022 PMCID: PMC9245852 DOI: 10.3171/case2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.
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Affiliation(s)
| | - Vincent C. Ye
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Kerry A. Vaughan
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - James M. Drake
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Peter B. Dirks
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Michael D. Cusimano
- Divison of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; and
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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Marioni G, Blandamura S, Nicolè L, Denaro L, Cazzador D, Pavone C, Giacomelli L, Guzzardo V, Fassina A, Mazzoni A, D’Avella D, Martini A, Zanoletti E. Endoglin-based assessment of neoangiogenesis in sporadic VIII cranial nerve schwannoma. Pathol Res Pract 2019; 215:152648. [DOI: 10.1016/j.prp.2019.152648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
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Nicoletti G, Galvano G, Ponzo G, Raciti MV, Furnari M, Riolo C, Cannella A, Iacopino DG, Scavone A, Lo Bue E, Graziano F. Pediatric Trigeminal Schwannoma: From a "Minimally Invasive" to a Combined Endovascular and Surgical Management. World Neurosurg 2019; 129:552-554. [PMID: 31426264 DOI: 10.1016/j.wneu.2019.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - Gianluca Galvano
- Department of Diagnostic Imaging, Interventional Radiology and Neuroradiology, ARNAS Garibaldi, Catania, Italy
| | | | - Maria Vittoria Raciti
- Department of Radiology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | | | - Carmelo Riolo
- Department of Neurosurgery, ARNAS Garibaldi, Catania, Italy
| | - Alfio Cannella
- Department of Diagnostic Imaging, Interventional Radiology and Neuroradiology, ARNAS Garibaldi, Catania, Italy
| | - Domenico G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Antonio Scavone
- Department of Diagnostic Imaging, Interventional Radiology and Neuroradiology, ARNAS Garibaldi, Catania, Italy
| | - Enrico Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy.
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Alafaci C, Grasso G, Granata F, Marino D, Salpietro FM, Tomasello F. Spontaneous Meckel's cave hematoma: A rare cause of trigeminal neuralgia. Surg Neurol Int 2015; 6:S445-7. [PMID: 26539319 PMCID: PMC4604649 DOI: 10.4103/2152-7806.166776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 11/04/2022] Open
Abstract
Background: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel's cave (MC) causing symptomatic TN is very rare. Case Description: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive neurological improvement. Conclusion: Despite the number of lesions potentially affecting the MC, spontaneous hemorrhage is rare but should be taken into account in the differential diagnosis.
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Affiliation(s)
- Concetta Alafaci
- Department of Neurosurgery, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | | | - Daniele Marino
- Department of Neurosurgery, University of Messina, Messina, Italy
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Mada Y, Ueki Y, Konno A. [Four cases of extracranial trigeminal benign neurogenic tumors]. NIHON JIBIINKOKA GAKKAI KAIHO 2015; 117:1356-61. [PMID: 25731017 DOI: 10.3950/jibiinkoka.117.1356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extracranial trigeminal schwannomas are rare tumors accounting for about 10% of all trigeminal schwannomas. We report herein on four cases of extracranial trigeminal benign neurogenic tumors. The patients were aged between 39 and 75 years; they consisted of one male and three females. The origins of the schwannomas consisted of the maxillary nerve in two cases and the mandibular nerve in two cases. All cases were surgically treated using a transmaxillary approach in three cases, and a combination of the transcervical-parotid approach with a midline mandibulotomy in one case. In two cases, the schwannomas located in the pterygopalatine fossa were removed using a transmaxillary approach with the endoscope and the surgical microscope. Two patients underwent selective intravascular embolization of the feeding artery to reduce intraoperative bleeding, and they were less invasively treated via the transmaxillary approach.
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Yang B, Su M, Li H, Li J, Ouyang J, Han Z. Use of submandibular gland flap for repairing defects after tumor resection in the infratemporal region. J Craniomaxillofac Surg 2014; 43:87-91. [PMID: 25465488 DOI: 10.1016/j.jcms.2014.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/03/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To investigate the application of submandibular gland flap with facial artery and vein pedicle, for repairing defects following tumor resection in the infratemporal region. PATIENTS AND METHODS Fifteen patients, including eight males and seven females ranging in age from 21 to 73 years, underwent surgical resection of tumors in the infratemporal region. Tumors were exposed using the submandibular incision approach and completely resected after pulling and rotating the mandible laterally. Mandibular osteotomy was performed for larger tumors or those that were not completely exposed. After tumor resection, the submandibular gland flap was used to fill up the residual defect following tumor resection. RESULTS The incisions healed well without exudation or infection (primary healing) postoperatively in all the patients. Long-term follow-up showed no tumor recurrence in all cases. Seven of the patients who underwent mandibular ramus osteotomy had numbness of the lower lip due to inferior alveolar nerve injury. No other complications were observed postoperatively. CONCLUSION The submandibular gland flap with facial artery and vein pedicle is a reliable, effective, and easy approach for repairing the defects caused by tumor resection in the infratemporal region, and has great potential for application in the clinical setting.
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Affiliation(s)
- Bin Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Ming Su
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Hua Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jinzhong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jiajie Ouyang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
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