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Large oculomotor schwannoma presenting as a parasellar mass: A case report and literature review.

Prabhu SS, Bruner JM - Surg Neurol Int (2010)

Bottom Line: The radiological features of the mass were more consistent with a medial sphenoid wing meningioma causing brain stem compression.The patient developed complete third nerve palsy postoperatively.Intraoperative anatomical preservation of the third nerve was impossible given its course in the tumor.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

ABSTRACT

Background: Large schwannomas arising from the oculomotor nerve are very rare. The common site of tumor occurrence in this nerve is the segment within the interpeduncular cistern and the cavernous sinus.

Case description: We report a case of a large left-sided oculomotor nerve schwannoma with minimal clinical signs and symptoms of oculomotor nerve involvement resembling a large parasellar mass. The radiological features of the mass were more consistent with a medial sphenoid wing meningioma causing brain stem compression. Complete resection of the tumor was achieved via a left pterional approach. The patient developed complete third nerve palsy postoperatively.

Conclusion: The management of these large benign tumors with brain stem compression includes surgical resection. Intraoperative anatomical preservation of the third nerve was impossible given its course in the tumor. We discuss the pertinent literature and management of large oculomotor schwannomas.

No MeSH data available.


Related in: MedlinePlus

A coronal gadolinium-enhanced contrasted T1-weighted MRI scan showing a large parasellar/ suprasellar mass with significant brainstem compression (a). A postoperative coronal gadolinium-enhanced T1-weighted MRI contrast scan 3 months later showing a complete resection of the mass with brainstem compression reversed (b). A combined subtemporal and anterior Sylvian fissure-splitting approach was used to reach the tumor
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Figure 0003: A coronal gadolinium-enhanced contrasted T1-weighted MRI scan showing a large parasellar/ suprasellar mass with significant brainstem compression (a). A postoperative coronal gadolinium-enhanced T1-weighted MRI contrast scan 3 months later showing a complete resection of the mass with brainstem compression reversed (b). A combined subtemporal and anterior Sylvian fissure-splitting approach was used to reach the tumor

Mentions: A 38-year-old female developed symptoms of headache, dizziness, occasional diplopia and drooping of the left eyelid. Imaging confirmed a large left suprasellar mass (3.5 cm in diameter) with midbrain compression, suggesting a meningioma [Figures 1, 2 and 3]. A biopsy via a right pterional approach at an outside institution showed a benign spindle-cell neoplasm. The material was too small to definitively distinguish between meningioma and schwannoma. No tumor was resected at this operation. At MDACC her examination confirmed a bi-temporal hemianopsia related to previous surgery. There were no clinical signs of oculomotor palsy. The preoperative diagnosis in our patient was a meningioma, given the paucity of clinical findings. A left pterional craniotomy, drilling of the sphenoid wing and wide splitting of the Sylvian fissure for tumor access was carried out. The tumor was well encapsulated. After substantial debulking of the mass, the third nerve appeared from the interpeduncular cistern as a bundle and ran straight into the base of the mass. No other significant attachments of the tumor were recognized. Postoperatively, the patient developed complete third nerve paralysis on the left side. At 6-month follow-up, she continued to have complete third nerve palsy with no evidence of residual tumor [Figures 1, 2 and 3].


Large oculomotor schwannoma presenting as a parasellar mass: A case report and literature review.

Prabhu SS, Bruner JM - Surg Neurol Int (2010)

A coronal gadolinium-enhanced contrasted T1-weighted MRI scan showing a large parasellar/ suprasellar mass with significant brainstem compression (a). A postoperative coronal gadolinium-enhanced T1-weighted MRI contrast scan 3 months later showing a complete resection of the mass with brainstem compression reversed (b). A combined subtemporal and anterior Sylvian fissure-splitting approach was used to reach the tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908360&req=5

Figure 0003: A coronal gadolinium-enhanced contrasted T1-weighted MRI scan showing a large parasellar/ suprasellar mass with significant brainstem compression (a). A postoperative coronal gadolinium-enhanced T1-weighted MRI contrast scan 3 months later showing a complete resection of the mass with brainstem compression reversed (b). A combined subtemporal and anterior Sylvian fissure-splitting approach was used to reach the tumor
Mentions: A 38-year-old female developed symptoms of headache, dizziness, occasional diplopia and drooping of the left eyelid. Imaging confirmed a large left suprasellar mass (3.5 cm in diameter) with midbrain compression, suggesting a meningioma [Figures 1, 2 and 3]. A biopsy via a right pterional approach at an outside institution showed a benign spindle-cell neoplasm. The material was too small to definitively distinguish between meningioma and schwannoma. No tumor was resected at this operation. At MDACC her examination confirmed a bi-temporal hemianopsia related to previous surgery. There were no clinical signs of oculomotor palsy. The preoperative diagnosis in our patient was a meningioma, given the paucity of clinical findings. A left pterional craniotomy, drilling of the sphenoid wing and wide splitting of the Sylvian fissure for tumor access was carried out. The tumor was well encapsulated. After substantial debulking of the mass, the third nerve appeared from the interpeduncular cistern as a bundle and ran straight into the base of the mass. No other significant attachments of the tumor were recognized. Postoperatively, the patient developed complete third nerve paralysis on the left side. At 6-month follow-up, she continued to have complete third nerve palsy with no evidence of residual tumor [Figures 1, 2 and 3].

Bottom Line: The radiological features of the mass were more consistent with a medial sphenoid wing meningioma causing brain stem compression.The patient developed complete third nerve palsy postoperatively.Intraoperative anatomical preservation of the third nerve was impossible given its course in the tumor.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

ABSTRACT

Background: Large schwannomas arising from the oculomotor nerve are very rare. The common site of tumor occurrence in this nerve is the segment within the interpeduncular cistern and the cavernous sinus.

Case description: We report a case of a large left-sided oculomotor nerve schwannoma with minimal clinical signs and symptoms of oculomotor nerve involvement resembling a large parasellar mass. The radiological features of the mass were more consistent with a medial sphenoid wing meningioma causing brain stem compression. Complete resection of the tumor was achieved via a left pterional approach. The patient developed complete third nerve palsy postoperatively.

Conclusion: The management of these large benign tumors with brain stem compression includes surgical resection. Intraoperative anatomical preservation of the third nerve was impossible given its course in the tumor. We discuss the pertinent literature and management of large oculomotor schwannomas.

No MeSH data available.


Related in: MedlinePlus