Intraparenchymal schwannoma with calcification of the temporal lobe: Case report and literature review

Complete excision of a giant chondrosarcoma within the cavernous sinus: a case report and literature review

BACKGROUND

Primary skull base chondrosarcoma (SBC) is a rare malignant central nervous system tumor, often involving the cavernous sinus. Complete excision of tumors invading this region is exceptionally challenging due to the presence of the internal carotid artery and numerous nerves within the cavernous sinus, particularly in cases with substantial tumor volume.

CASE PRESENTATION

This report describes a rare case of a massive primary SBC pushing the lateral wall of the cavernous sinus, measuring approximately 6.6 cm × 4.5 cm × 4.4 cm. Utilizing neurophysiological monitoring and intraoperative navigation, we successfully achieved complete tumor resection along the membranous structure via a left modified pterional approach (pterional-zygomatic arch-subdural-infratemporal approach), employing tools such as a cavitron ultrasonic surgical aspirator (CUSA) and piezosurgery. During the excision, localized rupture and bleeding of the internal carotid artery occurred, but prompt repair and anastomosis were performed. Postoperatively, the patient's symptoms markedly improved, and good reperfusion of the internal carotid artery was observed without new severe complications. The postoperative pathological diagnosis, according to the World Health Organization classification, was Grade 1 chondrosarcoma; therefore, radiotherapy was not administered. Magnetic resonance imaging at the 8-month follow-up showed no residual tumor or recurrence.

CONCLUSIONS

This case highlights that surgical complete excision of large intracavernous SBCs, while preserving vital neurovascular functions, is feasible and paramount for achieving favorable outcomes, particularly for Grade 1 and 2 SBCs, which comprise 82.4% of all subtypes. The use of a modified left pterional approach, intra-capsular tumor resection techniques, alongside CUSA and piezosurgery, provides valuable insights and serves as a reference for achieving complete excision of SBCs within the cavernous sinus.

Brainstem intraparenchymal schwannoma: A case report and literature review

Background:

Intracranial intraparenchymal schwannomas (IS) are rare tumors that have mainly been described in case reports. Here, we report on a case of a brainstem IS and included a comprehensive literature review.

Case Description:

A 74-year-old man presented with progressive gait disturbances. CT- and MRI-imaging revealed a contrast-enhancing mass accompanied by a cyst in the dorsolateral pons. Hemangioblastoma was suspected and surgery was advised. During surgery, gross total resection of a non-invasive tumor was performed. Postoperative recovery was uneventful. Based on histopathological examination, the intraparenchymal brainstem tumor was diagnosed as schwannoma.

Conclusion:

Our extensive review illustrates that ISs are benign tumors that most often present in relatively young patients. Malignant cases have been described but form an extremely rare entity. Preoperative diagnosis based on radiological features is difficult but should be considered when peritumoral edema, calcifications, and cysts are noted. In benign cases, gross total resection of the lesion is curative. To adequately select this treatment and adjust the surgical strategy accordingly, it is important to include IS in the preoperative differential diagnosis when the abovementioned radiological features are present.

Intraparenchymal Schwannoma: A Rare Entity

A 60-year-old woman noted headaches, transient visual obscurations and pulsatile tinnitus. She had Frisén grade 4 papilloedema. Brain magnetic resonance imaging showed a large subfrontal cystic mass with ring enhancement. Tumour pathology was in-keeping with an intraparenchymal schwannoma. This uniquely rare tumour is discussed.