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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

Immunohistochemistry for epithelial membrane antigen was negative in the schwannoma. Epithelial membrane antigen immunohistochemistry, ×20
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Figure 0007: Immunohistochemistry for epithelial membrane antigen was negative in the schwannoma. Epithelial membrane antigen immunohistochemistry, ×20

Mentions: Pathologic description: Multiple rubbery fragments of tumor aggregated to a mass about 3.5 cm in diameter. Multiple histologic sections showed typical appearance of a benign schwannoma with short-spindled cells and random nuclear pleomorphism [Figure 4a]. Most of the tissue was the denser, more organized, Antoni A type, with very few Antoni B areas. No Verocay bodies were seen. Focal perivascular hemorrhage was identified. Occasional histiocytes and small aggregates of mature lymphocytes were sometimes present around blood vessels [Figure 4b]. A few blood vessels showed mural hyalinization. Immunohistochemistry for S-100 protein showed diffuse strong nuclear and cytoplasmic reactivity in the schwannoma [Figure 4c]. Because of the consideration of meningioma, an immunohistochemical stain for epithelial membrane antigen was performed but was entirely nonreactive [Figure 4d].


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

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

Immunohistochemistry for epithelial membrane antigen was negative in the schwannoma. Epithelial membrane antigen immunohistochemistry, ×20
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0007: Immunohistochemistry for epithelial membrane antigen was negative in the schwannoma. Epithelial membrane antigen immunohistochemistry, ×20
Mentions: Pathologic description: Multiple rubbery fragments of tumor aggregated to a mass about 3.5 cm in diameter. Multiple histologic sections showed typical appearance of a benign schwannoma with short-spindled cells and random nuclear pleomorphism [Figure 4a]. Most of the tissue was the denser, more organized, Antoni A type, with very few Antoni B areas. No Verocay bodies were seen. Focal perivascular hemorrhage was identified. Occasional histiocytes and small aggregates of mature lymphocytes were sometimes present around blood vessels [Figure 4b]. A few blood vessels showed mural hyalinization. Immunohistochemistry for S-100 protein showed diffuse strong nuclear and cytoplasmic reactivity in the schwannoma [Figure 4c]. Because of the consideration of meningioma, an immunohistochemical stain for epithelial membrane antigen was performed but was entirely nonreactive [Figure 4d].

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