Endoscopic Management of Recurrent Anterior Skull Base Schwannoma

Jivianne T Lee,Lester D R Thompson,Rohit Garg,David B Keschner,Terry Shibuya

doi:10.4236/ijohns.2013.22013

Jivianne T Lee, Lester D R Thompson + Show 3 more

Open Access

https://doi.org/10.4236/ijohns.2013.22013

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Abstract

Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection. Study Design: Case report and review of the literature. Methods: The clinical presentation, radiographic features, histopathologic characteristics, surgical approach, and patient outcome were examined in the context of a literature review. Results: A 43-year-old woman presented with a 9-month history of left facial pain and pressure. She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007. Magnetic resonance imaging (MRI) and nasal endoscopy revealed a left ethmoid mass measuring 2.2 cm × 2.7 cm × 2.4 cm abutting the anterior skull base. The tumor was completely removed using a transnasal endoscopic approach, and the anterior skull base reconstructed with tensor fascia lata graft. Histology of the specimen showed schwannoma, and there has been no evidence of tumor recurrence nor CSF leak after 24 months of follow-up. Conclusion: With continual advances in surgical technique and instrumentation, sinonasal schwannomas have become increasingly more amenable to endoscopic resection even in the case of recurrence and skull base involvement.

Highlights

First described by Virchow in 1908, schwannomas are benign, slow-growing, well-encapsulated tumors that arise from Schwann cells, derived from ectoderm, which provide myelin insulation for peripheral motor, sensory, autonomic, and cranial nerves [1]
The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection
She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007

Summary

Introduction

First described by Virchow in 1908, schwannomas (peripheral nerve sheath tumors) are benign, slow-growing, well-encapsulated tumors that arise from Schwann cells, derived from ectoderm (neural crest), which provide myelin insulation for peripheral motor, sensory, autonomic, and cranial nerves [1]. The nasoethmoid complex is the most commonly affected site, followed by the maxillary sinus, nasal cavity, sphenoid sinus, and frontal sinus [2,3]. The primary treatment modality has been surgical excision via external procedures [4]. Recent advances in endoscopic techniques have resulted in an increasing number of cases being managed with less invasive methods [4]. We present a unique case of recurrent schwannoma of the ethmoid cavity and anterior skull base successfully treated with endoscopic resection and reconstruction of the skull base defect. The clinical presentation, radiographic findings, pathologic features, surgical approach, treatment, and outcome are discussed

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