Endoscopic Resection of Sinonasal Tract Schwannoma: Presentation, Treatment, and Outcome in 10 Cases

Schwannoma of the nasal cavity: A case report and review of the literature

Sinonasal schwannoma (SNS) is a rare entity with 4% occurring at this location and only 36 cases described in the literature. A 22-year-old woman presented recurrent unilateral epistaxis, hyposmia, unilateral nasal obstruction, and hemicranial headache for a year. The endoscopic examination showed a tissue mass filling the left nasal cavity and nasopharynx. Imaging showed a mass that occupied the left posterior ethmoid cells in the hyposignal T1, hyposignal T2, and gadolinium enhancing. A preoperative biopsy was made and the diagnosis was a schwannoma. The tumor mass was completely removed under general anesthesia. The final histopathological study reconfirmed the diagnosis of schwannoma. Six months after surgery, control endoscopic and imaging showed the absence of tumor recurrence. SNS is a rare entity and its diagnosis is generally based on a histological examination. Therefore, the possibility of schwannoma must be considered in front of a mass of the nasal fossa.

Nasal Cavity Schwannoma-A Case Report and Review of the Literature

Schwannomas are rare slow-growing benign tumors arising from Schwann cells lining the nerve sheaths. Head and neck schwannomas account for about one-third of all cases, and only 4% of them arise from the sinonasal tract. Its diagnosis is based on histology and immunohistochemistry. Complete surgical excision is the most recommended treatment option, and endoscopic surgery has been widely performed in recent years. In this study, we presented a case of a 55-year-old female with schwannoma arising from the lateral wall of the nasal cavity, causing epistaxis and rhinorrhea. The patient underwent endoscopic excision with prompt resolution of symptoms. The reported cases of nasal cavity schwannoma were reviewed and summarized for educational purposes.

Sphenoid sinus schwannoma with adhesion to the carotid canal

Few reports have been made on the presentation and treatment of schwannomas originating in the sphenoid sinus due to their rarity. We report the case of a 60-year-old woman who presented with a cyst-like mass in the right sphenoid sinus on magnetic resonance imaging. Computed tomography showed a bone defect in the internal carotid artery (ICA) and enlargement of the round foramen on the affected side. A histopathological diagnosis of schwannoma was made, and endoscopic sinus surgery was performed. The anterior part of the tumor could be easily removed by aspiration; however, its adhesion to the ICA was remarkable, and its boundaries were unclear. Although partial paralysis of the maxillary nerve remained, no recurrence occurred for over 10 years. Careful evaluation should be performed to check for bone defects in the nerve to differentially diagnose schwannoma from cystic masses of the sphenoid sinus. Additionally, excision of masses similar to the presented case may expectedly be difficult because of unclear excisional margins and strong capsule adherence to important organs such as the ICA. Moreover, correct imaging, histopathological diagnosis, and appropriate informed consent are essential before surgery.

The Varied Presentations of Sinonasal Region Schwannomas: Apropos of Four Cases

Schwannomas of the sinonasal compartment are rare benign neoplasms of peripheral nerve sheath origin and constitute ~ 4% of all head and neck schwannomas. The presentation may simulate a range of benign and intermediate grade pathologies. Management involves surgical excision via open or endoscopic approach. To describe the clinico-epidemiological characteristics and surgical outcomes in sinonasal region schwannoma patients operated at our institute. The study is a descriptive case series of patients with sinonasal region schwannomas treated at our institution. A retrospective search of electronic database of the Department of ENT and Head and Neck Surgeries and Department of Pathology was conducted from January 2013 to January 2019. The various demographic and clinical details of the patients were extracted. A total of four patients operated for sinonasal region schwannoma were identified. The involved sites were nasal dorsum, nasal cavity, pterygopalatine fossa and infratemporal fossa. The mild, non-specific symptoms resulted in patients ignoring their symptoms for a while initially and presenting late. The nasal dorsum lesion was revealed as a surprise during open rhinoplasty for correction of nasal deformity. Complete excision was achieved in all the cases and no recurrence has been noticed during the follow up (varying from 6 months to 6 years) till date. The diverse clinical manifestations and approaches to the treatment of schwannomas in this specific region are discussed. The surgical excision is the standard of care in dealing with these neoplasms. This series highlights the rarity of this pathology in the sinonasal area, diagnostic surprises and the decision making to choose the correct surgical approach for complete excision. Once excised completely, recurrence is not expected.

Purely Endonasal Endoscopic Approaches for Extracranial Trigeminal Nerve Schwannoma

OBJECTIVE

The aim of this study is to assess the effectiveness and safety of purely endonasal endoscopic resection of extracranial trigeminal schwannomas (TGSs), with assessment of surgical and clinical outcomes in order to identify optimal candidates for an endonasal endoscopic approach (EEA).

METHODS

A retrospective review of patient's records operated for TGSs between 2008 and 2021 was conducted. Patients operated with a purely EEA were included in this study. Pictures from a frozen fresh cadaver head dissection were used to demonstrate the surgical approach and to show anatomic relationships, complexity of the surgical area and safe corridors for surgery.

RESULTS

A total of 5 patients (4 females and 1 male) were operated for TGS. All patients had facial numbness (100%) as a presenting symptom, followed by facial pain in 2 patients (40%), and orbital pain in 1 (20%). Also, 3 patients (60%) had a tumor originating at the level of the foramen ovale and 2 (40%) at the foramen rotundum. The mean tumor diameter was 3,7 ± 2 cm. Gross total resection were achieved in all cases. Postoperatively, 1 patient had severe mastication problems, 1 had blurred vision, and in the long-term follow-up, 1 had frontal sinusitis. The mean follow up was 106.6 (min:49, max:132, SD: 29.82) months. No recurrences were detected.

CONCLUSIONS

In cases with the extradural TGS having limited extension into Posterior Cranial Fossa, or located in the Middle Cranial Fossa, a purely EEA is possible even for tumors bigger in size. Unilateral endonasal corridors are adequate for resection in most cases.

Schwannoma of the sinonasal tract: case report with review of the literature

Schwannomas of the sinonasal tract are rare, accounting for <4% of head and neck schwannomas. We report the case of a 61-year-old male who presented with unilateral nasal symptoms. Examination and imaging revealed a unilateral polyp at the level of the middle turbinate, with an initial biopsy suggestive of an inflammatory polyp. Due to the persistence of the patient's symptoms and his polyp despite medical therapy, endoscopic nasal polypectomy was performed. The histology surprisingly showed a schwannoma. No further interventions were carried out, and the patient remains disease-free 6 months postoperatively. A review of the literature comprising 60 cases is included. An optimal clinical approach to the investigation and management of schwannomas of the sinonasal tract is subsequently discussed.

Differential Diagnosis Between Nasal Septal Schwannoma and Nasal Septal Neurofibroma

Recently, as the authors experienced nasal septal schwannoma and nasal septal neurofibroma with similar clinical symptoms but different endoscopic findings, the authors tried to review all the literatures previously reported on the "Nasal septal schwannoma and Nasal septal neurofibroma." The aim of this study is to thoroughly review previously reported patients with nasal septal schwannomas and neurofibromas and to describe similar and different features focusing on the differential diagnosis between the 2 entities. On the basis of our review, the authors made some important conclusions. First, benign peripheral nerve tumors originating from the nasal septum are uncommon. Especially, nasal septal neurofibroma is extremely rare that only 5 patients were reported. So, more clinical reports of benign peripheral nerve tumors are necessary to elucidate the differences between nasal septal schwannoma and nasal septal neurofibroma. Second, there are some similar features between nasal septal schwannoma and nasal septal neurofibroma such as clinical symptoms, endoscopic findings, and treatment strategy. However, since there seem to be some differences in nasal endoscopic findings, they may be helpful for the provisional diagnosis, and so more patients should be reported to verify that point. Third, image study, especially magnetic resonance imaging (MRI), is considered to be a useful tool for differential diagnosis of benign peripheral nerve tumors originating from the nasal septum. So, more clinical reports reporting MRI findings are needed to verify the differences. Last, because of distinctive histologic appearances of benign peripheral nerve tumors, it is usually not difficult to make the distinction between nasal septal schwannoma and nasal septal neurofibroma. However, immunohistochemical stains including S-100 protein, calretinin, CD 34, factor XIIIa, and CD56 are necessary when it is difficult to differentiate between 2 disease entities.

Nasal septal schwannoma: a rare sinonasal tumour with certain peculiarities

Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.

Nasal Septal Schwannoma: Advances in Diagnosis and Treatment

The nasal septum is one of the rarest sites of origin of schwannomas. Recently, as the authors experienced a patient with nasal septal schwannoma completely removed by transnasal endoscopic approach, the authors tried to review all the literatures reported since Berlucchi's report in 2000. To the best of our knowledge, only 18 patients with nasal septal schwannoma in the literatures written by English-language have been reported. The purpose of this study is to describe our recent experience and thoroughly review our collected patients with nasal septal schwannoma with particular emphasis on therapeutic options. Additionally, it is to describe the changes in clinical symptoms, diagnosis, and treatment of nasal septal schwannoma by comparing our data with Berlucchi's data. Based on our review, the authors suggest some conclusions. First, since common symptoms were nonspecific like other intranasal tumors, the authors should keep in mind that nasal septal schwannoma is included in the differential diagnosis of unilateral nasal mass pathologies with a high degree of suspicion on the basis of the endoscopic findings. Second, although there is no diagnostic computed tomography (CT) finding of nasal septal schwannoma, CT scan with contrast enhancement is helpful in defining the origin and location of the tumor and the involvement of vital structures. Third, combined immunohistochemical staining for S-100 protein, calretinin, and CD56 in addition to the light microscopic findings can be very useful as a simple, easy, and reliable method for definite diagnosis. Last, transnasal endoscopic surgery is the most suitable approach for treating any size and location of nasal septal schwannomas.

A Diagnostic Dilemma: Multiple Primary Intracranial Tumors Without Vestibular Schwannomas

Sinonasal schwannomas with intracranial extension are exceedingly rare, with only 7 cases reported in the literature. Schwannomas can be isolated or multiple and are commonly associated with familial disorders such as neurofibromatosis 2 (NF 2) or familial schwannomatosis or in sporadic cases seen in sporadic schwannomatosis. Nearly all people with NF2 older than 30 years of age will have the hallmark of bilateral vestibular schwannomas (VS). This case highlights a reported case of an adult with separate primary intracranial tumors. We review the diagnostic criteria of NF2 and schwannomatosis, a recently described third variant of neurofibromatosis. In this case, we incorporate family history, histopathology, and the pathophysiology of both disorders to help determine a diagnosis for this patient.

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas

BACKGROUND

The purpose of this study was to report our experience with the endoscopic management of sinonasal schwannomas, analyzing the advantages, limitations, and outcomes of the technique.

METHODS

A retrospective analysis was carried out on 11 patients treated endoscopically between 2000 and 2014 at a single institution.

RESULTS

Eight patients underwent an exclusive endoscopic endonasal approach, whereas, in 3 patients, an osteoplastic flap was combined because of massive or lateral frontal sinus involvement. The tumor extended into the orbit in 5 cases, and involved the skull base in 5 patients who required a concomitant endoscopic duraplasty. No evidence of disease was observed in 10 patients after a mean follow-up of 90.1 months (range, 14-189 months). One patient was alive with persistence of disease, although asymptomatic.

CONCLUSION

The endoscopic endonasal approach is a valid alternative for the vast majority of sinonasal schwannomas with minimal morbidity for the patient. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2074-E2082, 2016.