Intra-suprasellar schwannoma originating from the diaphragma sellae

Ectopic schwannoma of the sellar region in a 1-year-old child: A case report and review of literature

Background:

Schwannomas are cranial and spinal nerves’ sheath tumors accounting for up to 8% of all intracranial neoplasms. Although typical intracranial schwannomas originate from Schwann cells surrounding cranial nerves, ectopic schwannomas are not associated with a known cranial nerve or have an unknown origin. The location of schwannomas may impose clinical challenges. Sellar region schwannomas are rare whether it is ectopic or not. Herein, we report a pediatric case of a 1-year-old female with ectopic, intra-supra sellar with a literature review. We report the first case of juvenile ectopic schwannoma in the sellar region.

Methods:

A PubMed Medline database search was performed by the following combined formula of medical subject headings (MESH) terms and keywords: ((sella turcica [MeSH Terms]) OR (sella*[Title/Abstract]) OR (ectopic [Title/Abstract]) AND ((neurilemmoma [MeSH Terms]) OR (schwannoma [Title/Abstract]) OR (neuroma [Title/Abstract]) OR (neurinoma [Title/Abstract])).

Results:

Total results of 206 articles were obtained. In exclusion of intraparenchymal and intraventricular schwannomas, only 34 articles remained. Thirty-nine cases were included in 34 articles. According to the reported cases, intrasellar schwannomas are more common in elderly individuals in an average of 49.5 years (range: 19– 79 years). They have a good prognosis and affect males to females equally (20:19).

Conclusion:

Ectopic schwannoma sited in the sellar region is rare. It is the first case to be reported in the pediatric age group with a literature review. This lesion should be highlighted and included in the differential diagnosis of sellar mass.

Primary intrasellar schwannoma with intratumoral hemorrhage mimicking pituitary apoplexy: A case report

Tumours growing in the sella turcica are mostly pituitary adenomas. We describe a rare case of primary intrasellar schwannoma with intratumoral bleeding. A 38-year-old man presented with headache in association with bilateral supratemporal quadrantopsia. MRI showed an intrasellar mixed signal mass lesion with suprasellar extension. The majority of the pituitary hormones were normal. He was diagnosed as non-functional pituitary adenoma with pituitary apoplexy. Subtotal resection was achieved eventually via an endoscopic transnasal trans-sphenoidal approach. The histopathologic diagnosis was schwannoma. It is the first intrasellar schwannoma with intratumoral hemorrhage in literature to date. It implied that the primary intrasellar schwannoma has potential risk of intratumoral bleeding, which should be considered in the differential diagnoses of sellar lesions.

"Pure" Suprasellar Schwannoma Presented with Communicating Hydrocephalus: A Case Report

Schwannoma is a benign peripheral nerve sheath tumor originating from Schwann cells. Most intracranial schwannomas arise from vestibular nerve and schwannoma in the suprasellar region is extremely rare. A 64-year-old man presented with walking disturbance and blurred vision for three months. Lateral hemianopsia in the left eye and brachybasia were observed. Magnetic resonance imaging revealed a suprasellar tumor with strong contrast enhancement associated with communicating hydrocephalus. The cerebrospinal fluid tap test improved gait disturbance. Hypothalamic stimulation test revealed hypo-reaction of GH, FSH and LH. After ventriculo-peritoneal shunting, the tumor was totally removed via a bilateral front-basal approach with a clinical diagnosis of craniopharyngioma. No adhesion was observed between the tumor and surrounding structures such as meninges and brain. The histopathological diagnosis was schwannoma. Here we report a case of suprasellar schwannoma associated with communicating hydrocephalus that has not ever been previously reported, with special reference to its pathogenesis.

Computed tomography and magnetic resonance imaging findings of intrasellar schwannoma: A case report and literature review

Intrasellar schwannoma is extremely rare, and only a few cases have been reported in the literature to date. In the present study, the clinical, radiological and pathological features of a 50-year-old male patient with primary intrasellar schwannoma are presented. The patient presented with decreased visual acuity, and a subsequent computed tomography (CT) scan revealed a giant well-demarcated intrasellar mass with suprasellar extension, without cavernous sinus invasion. The lesion was slightly hyperdense with heterogeneous enhancement. On magnetic resonance imaging (MRI), the mass was isointense on T1 weighted images (WI), and slightly hyperintense on T2WI, with significant heterogeneous enhancement. Previous literature was reviewed to summarize the CT and MRI characteristics of intrasellar schwannoma. Despite the rarity of this tumor, intrasellar schwannoma must be included in the differential diagnosis of intrasellar lesions.

Hard calcified intrasellar schwannoma mimicking pituitary adenoma: a case report and review of the literature

BACKGROUND

Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas are common in the central nervous system. The aim of the present study is to describe a calcified intrasellar schwannoma case.

MATERIALS AND METHODS

We represent a 45-year-old woman who had suffered from headaches; right side facial pain and visual disturbance which had worsen during the last week prior to admission. Physical examinations were normal except for the bitemporal visual field hemianopia which match with perimetry examination. MRI demonstrated an unusual seemingly calcified mass lesion in the sellar region which was mimicking pituitary macro adenoma.

RESULT

Total resection of the tumor achieved through endoscopic transnasal transsphenoidal approach by extracapsular dissection and pathologic examination of the tumor revealed calcified schwannoma.

CONCLUSION

The differential diagnoses of sellar and suprasellar lesions include pituitary adenomas, craniopharyngiomas, meningiomas, and many others. However, schwannoma is not usually included, because the occurrence of schwannoma in the sellar or suprasellar region is extremely rare. Only few cases of intrasellar schwannomas have been reported in the literature, all of which presented a suprasellar extension similar to that of our case. Fascinating surgical point is managing very firm tumor through transsphenoidal corridor which we handle it by very sharp, debulking and extracapsular removal.

Primary intrasellar schwannoma

Intracranial schwannomas commonly arise from the eighth cranial nerve in the cerebellopontine angle. Schwannoma arising in the sella and extending into the suprasellar region is very rare and is easily mistaken for pituitary adenoma. To our knowledge, there have been only 12 previous reports. We present a patient with primary intrasellar schwannoma that clinically and radiologically resembled a pituitary adenoma (PA). Intra-operative findings differed from a PA, as the tumour had a firmer consistency. Gross total excision of the lesion was done via a transethmosphenoidal approach. Post-operatively the patient improved in visual acuity and visual fields. We have reviewed the literature and described the characteristics of such lesions.