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Dabas SK, Menon NN, Ranjan R, Gurung B, Tiwari S, Shukla H, Sharma A, Sinha A, Singh J, Singal R. Trigeminal Schwannoma - Case Report of a Rare Tumour. Indian J Otolaryngol Head Neck Surg 2023; 75:1180-1185. [PMID: 37274992 PMCID: PMC10235234 DOI: 10.1007/s12070-022-03405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
Schwannomas are benign nerve tumours arising from the Schwann cells. Approximately 25-45% of schwannomas occurs in the head and neck region. Majority of schwannomas in the head and neck region arise from the vagus nerve. Trigeminal schwannomas account for about 0.2% of all intracranial tumours. Trigeminal schwannomas can originate from any section of the fifth cranial nerve, from the root to the distal extracranial branches, but majority develops from the Gasserian ganglion, usually growing in the middle cranium. Most common presenting symptom is facial pain. MRI is the imaging modality of choice and CT scan usually serves as a supplementary imaging especially for skull base tumours. 47 year old male patient presented to the outpatient department with complains of swelling over the left side of palate. Contrast enhanced CT scan demonstrated a large bilobed heterogeneously enhancing soft tissue lesion in the left infratemporal fossa with widened foramen ovale and extension of lesion into the Meckel's cave, larger contiguous component extending into ramus of mandible. MRI scan showed a large lobulated mass in the left masticator space with intracranial extension. Biopsy of the lesion was suggestive of schwannoma. The patient underwent left composite resection with dural repair and free flap reconstruction. Post operatively, on day 5 he developed features of meningitis for which he was treated conservatively and later discharged in stable condition. Trigeminal schwannomas are rare tumours with very low chance of malignant transformation which commonly presents with facial pain. MRI is the imaging modality of choice. Complete surgical excision is the treatment of choice.
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Affiliation(s)
- Surendra K Dabas
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Nandini N Menon
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Reetesh Ranjan
- Senior consultant in surgical oncology, Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Bikas Gurung
- Senior consultant in surgical oncology, Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Sukirti Tiwari
- Department of Surgical oncology, FHNO Fellow, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Himanshu Shukla
- Senior consultant in surgical oncology, Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Ashwani Sharma
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Ajit Sinha
- Department of Surgical oncology, FHNO Fellow, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Jasbir Singh
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Rishu Singal
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, 110005 Delhi, India
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Poorna T A, Jr L, Ek J, John B, S N, S S. Extracranial schwannoma of the maxillary nerve misdiagnosed as trigeminal neuralgia in an elderly patient with schizophrenia - A diagnostic dilemma. SPECIAL CARE IN DENTISTRY 2023; 43:276-280. [PMID: 35916362 DOI: 10.1111/scd.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
The present paper discusses the diagnostic challenges we faced in a 60-year-old woman with a history of schizophrenia, presenting with left unilateral facial pain for the past three months. Based on the elaborate clinical examination and diagnostic nerve blocks, the patient was diagnosed with trigeminal neuralgia (TN) and non-surgical therapy commenced. Further investigations with magnetic resonance imaging (MRI) and ultrasound-guided fine needle aspiration cytology (FNAC) revealed the presence of an extracranial schwannoma involving a branch of the maxillary nerve. The patient was symptomatically relieved after surgical excision of the benign tumor under general anesthesia. Hence, we emphasize the need for special care and attention in psychiatric patients presenting with orofacial pain.
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Affiliation(s)
| | - Lokesh Jr
- Government Dental College, Kottayam, Kerala, India
| | - Joshna Ek
- Government Dental College, Kottayam, Kerala, India
| | - Bobby John
- Government Dental College, Kottayam, Kerala, India
| | - Neethu S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
| | - Shankar S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
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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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