Sinonasal Schwannomas Research Articles

A RARE CASE REPORT- NASAL COLUMELLAR SCHWANNOMA WITH REVIEW OF LITERATURE

Background: Schwannomas are benign tumors, that originate from Schwann cells. Less than 4% of these tumors arise in the sinonasal tract. Columellar involvement is extremely rare. Case Report: A 16 year old male with 5 months history of bilateral nasal obstruction and swelling in the right nasal cavity presented to our OPD. On physical examination, mass arising from right columellar region associated with hypervascularity observed. The computed tomography revealed heterogenous soft-tissue density in the right anterior nasal cavity. The mass was excised in toto via upper gingivo-buccal incision. An oval, whitish, firm, well-encapsulated mass measuring 2.5×2×1cm was removed. Histopathological examination revealed Antoni A and Antoni B areas. Findings were thereby consistent with the diagnosis of nasal schwannoma. Post-operative course was uneventful. Discussion: Schwannomas are tumors originating from Schwann cells and can occur in various locations, including the head and neck region. Sinonasal schwannomas, though rare, can present with symptoms such as nasal obstruction, epistaxis, and facial swelling. Diagnosis relies on histological examination, while imaging helps delineate lesion extent. Treatment typically involves surgical resection, with different approaches based on tumor location. Notably, schwannomas generally have a low recurrence rate, except in cases associated with neurofibromatosis type 2. Conclusion: Nasal schwannomas are very rare in the sino-nasal tract, however they should be considered as apart of differential diagnosis for nasal masses.

Sinonasal Schwannomas: Imaging Findings and Review of Literature.

Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations. A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma. We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%). We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.

Sinonasal Schwannoma: Retrospective Review of Cases from 1997-2016 at A Tertiary Referral Centre

Sinonasal schwannomas (SNS) are benign neoplasms of peripheral nerve sheaths within sinonasal cavities and little is known about them. We aim to expand current literature by analysing all cases of SNS at the National University of Malaysia Medical Centre (UKMMC). There were five females and one male in this study. Mean age was 52.3±2.1 years (range 42-75). The mean tumour size was 3.6cm±0.1 (range 1.50-5.90cm). Tumours originated from outside the sinonasal cavities (n=4) and inside (n=2). Extension was present in five patients. The sinonasal cavity most frequently involved is the maxillary sinus (n=3). Clinical presentation corresponded to site of involvement with facial numbness being the most common presentation. All histopathologically diagnosed cases showed regions of Antoni A, Antoni B, Verocay Bodies and immunoreactivity with S100 protein. Four patients underwent Functional Endoscopic Sinus Surgery (FESS). The presentation of SNS corresponds to their site. Site of involvement is more informative than the site of origin. Endoscopy, CT scans and MRIs are helpful in facilitating an accurate diagnosis. SNS show specific histopathological findings and its main treatment is FESS.

Giant schwannoma of the left maxillary sinus - a rare case report

Abstract BACKGROUND. Polyps, cysts and mucocele are the commonest sinonasal tumors present unilaterally, as well as invasive tumors, such as inverted papillomas and squamous cell carcinomas. On the contrary, Schwannomas are rare lesions found in this area. MATERIAL AND METHODS. We present a case of a 48-year-old female who presented with a 2-year progressive history of left nasal obstruction, cranio-facial fullness sensation and pain, with intermittent epistaxis. The CT scan of the nose and paranasal sinuses showed complete opacification of the entire left nasal cavity and maxillary sinus, causing a deviated nasal septum to the right side. RESULTS. The tumor was completely excised endoscopically without any complication. Histopathology was consistent with that of a schwannoma. CONCLUSION. The diagnosis of sinonasal Schwannomas remains challenging, as it is a rare tumor and sometimes its clinical behaviour and imaging may be misleading. The treatment of choice for paranasal sinus schwannoma is complete excision of the tumor with good prognosis.

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

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

Endonasal Endoscopic Approach for Skull Base Neurofibroma: Is It Viable?

ABSTRACT Anterior skull base and sinonasal schwannomas are rare entities. Earlier, safest way to remove these tumors, with best success rates, was open craniofacial surgery but recently with introduction of endoscopic endonasal approach; complete resection of these rare entities is possible. We present one such case of skull base neurofibroma which was resected in entirety via a purely endoscopic endonasal approach. How to cite this article Gupta A, Tiwari MK, Chauhan N, Kaur N, Kim V. Endonasal Endoscopic Approach for Skull Base Neurofibroma: Is It Viable?. Clin Rhinol An Int J 2015;8(2):72-75.

Sinonasal Schwannoma: A Case Report and Updated Review of the Literature

Sinonasal schwannomas are rare, benign and slow-growing peripheral nerve sheath tumors without age, race, or gender predilection. We present the unusual case of a 59-year-old female who pre-sented with right-sided retro-orbital pressure and rhinorrhea. Radiographic imaging revealed a mass centered in the right superior nasal cavity with extension through the cribriform plate into the right more than the left subfrontal region. Biopsy confirmed the diagnosis of a sinonasal schwannoma, which was resected via nasal endoscopic surgery and ethmoidectomy. These tumors, albeit rare, should be considered in the differential diagnosis for patients presenting with a para-nasal sinus mass to ensure inclusion of this benign lesion and avoid unnecessary aggressive in-tervention.

Schwannomas of the Sinonasal Tract and Anterior Skull Base: A Systematic Review of 94 Cases

Schwannomas of the anterior skull base (ASB) and sinonasal tract are extremely rare. These lesions mimic other pathologies such as olfactory groove meningiomas, hemangiopericytomas, and esthesioneuroblastomas. Because of their low incidence, ASB and sinonasal tract schwannomas have not been well characterized. A systematic review of ASB and sinonasal tract schwannomas was conducted to further elucidate the presentation and surgical management of these lesions. A MEDLINE/PubMed search was performed, identifying 71 articles representing 94 cases of ASB and sinonasal schwannomas. Each case was analyzed for demographics, clinical presentation, anatomic location, radiographic features, and surgical treatment. In 94 patients with ASB and sinonasal schwannomas, 44 (46.8%) were exclusively sinonasal, 30 cases (31.9%) were exclusively intracranial, 12 (12.8%) were primarily intracranial with extension into the paranasal sinuses, and 8 (8.5%) were primarily sinonasal with intracranial extension. Headaches and nasal obstruction were the most common presenting symptoms occurring in 30.9 and 29.8% of cases, respectively. Magnetic resonance imaging typically showed a hyperintense mass on T2-weighted imaging (70%) and hypointense (41%) on T1-weighted imaging. Most patients underwent surgical gross total resection via craniotomy, endoscopic endonasal approach, rhinotomy, or other sinonasal approaches. Recurrence occurred in three cases ranging from 4 months to 13 years. Postoperative complications included cerebral spinal fluid leakage, bacterial meningitis, epidural hematoma, and pneumocranium. ASB and sinonasal schwannomas are rare lesions and should be considered in the differential diagnosis of ASB masses involving the cribriform plate with sinonasal extension. Gross total resection of these lesions should be considered the goal of operative management.

Expanded Endoscopic Endonasal Treatment of Primary Intracranial Tumors within the Paranasal Sinuses

Objective. Meningiomas and schwannomas represent a subset of primary intracranial tumors that are rarely identified exclusively in the paranasal sinuses. Here, we describe our experience with minimally invasive endoscopic endonasal approaches for the treatment of these tumors.Methods. We retrospectively reviewed the clinical, surgical, and radiographic characteristics of adults with pathologically confirmed sinonasal meningiomas and schwannomas located within the paranasal sinuses that were resected via an expanded endoscopic endonasal approach.Results. Five patients (1 male, 4 females) underwent an endoscopic endonasal approach for resection of sinonasal tumor. Clinical symptomatology most commonly included nasal obstruction, in addition to headache, jaw pain, anosmia, and chronic rhinosinusitis. Tumors were located exclusively within the sinonasal cavity and were on average 2.2 cm (range 1.4–3.8 cm). Pathology revealed 2 cases of meningioma and 3 cases of schwannoma. No evidence of tumor recurrence occurred over average followup of 1.5 years (range 0.11–3.9 years).Conclusion. Our case series suggests that an expanded endoscopic endonasal approach with a combined neurosurgical-otorhinolaryngologic team for the resection of sinonasal meningiomas and schwannomas offers an effective treatment option. Further studies that include a larger number of patients over a longer follow-up period are required to compare outcomes between minimally invasive and open approaches.

Endoscopic Management of Recurrent Anterior Skull Base Schwannoma

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.

CT and MR Imaging Findings of Sinonasal Schwannoma: A Review of 12 Cases

Schwannomas are benign tumors that are rarely found in the sinonasal cavity, and the purpose of this study was to characterize the CT and MR imaging findings of 12 patients with surgically proved sinonasal schwannomas. Assessed features include location, margin, shape, size, internal architecture, pattern and degree of enhancement, and associated bony wall changes. The characteristic CT and MR imaging findings of sinonasal schwannoma include a well-defined soft-tissue mass, most frequently occurring in the nasal cavity and ethmoid sinus with pressure remodeling of the adjacent bony wall. The tumors were isoattenuating on CT and predominantly isointense on both T1- and T2-weighted MR images, compared with the brain stem. Mild contrast enhancement on CT and strong enhancement on MR images were also demonstrated in most of the tumors, and cystic or hemorrhagic changes were noted in 2 cases.

Endoscopic resection of an anterior skull‐base Schwannoma

Sinonasal Schwannomas represent less than 4% of all head and neck Schwannomas. These neural sheath tumors arise from the ophthalmic and maxillary divisions of the trigeminal nerve, as well as autonomic nerves from sympathetic fibers of the carotid plexus and parasympathetic fibers of the sphenopalatine ganglion. Patients commonly present with nonspecific symptoms such as nasal obstruction, epistaxis, and anosmia. Nasal endoscopy usually reveals a unilateral polypoid mass. Diagnostic imaging with computed tomography (CT) and magnetic resonance (MR) is typically nonspecific. Diagnosis may be delayed due to the masquerade of common sinonasal conditions, such as allergic rhinitis and chronic rhinosinusitis. We report a case involving a 51-year-old male with an anterior skull-base Schwannoma that was excised endoscopically. Clinical features, imaging characteristics, histopathology, and treatment of sinonasal Schwannomas are discussed.

Diagnosis and Endoscopic Management of Sinonasal Schwannomas

Aims: Survey the clinical symptoms, radiological features, management, and long-term outcomes of sinonasal and anterior skull base schwannomas. Patients and Methods: Retrospective review of patients with sinonasal schwannomas treated from June 2001 through January 2010 at two academic institutions. Results: There were 4 women and 3 men in this study. The mean age was 46 years (range 17–68). The mean tumor size was 2.4 cm (range 1.4–3.8 cm). Tumor locations included ethmoid sinuses (3), nasal cavity (2) and pterygopalatine fossa (2). Six patients had endoscopic resections, while 1 was approached and resected via a lateral rhinotomy. The mean follow-up was 2.8 years. There were no tumor recurrences during the study period. Conclusions: Schwannomas of the paranasal sinuses and nasal cavity are uncommon tumors that can usually present with vague and nonspecific symptoms. Magnetic resonance imaging can suggest the diagnosis; however, a definitive diagnosis is made by correlation with histopathological findings. Treatment is complete surgical resection. This study illustrates the effectiveness of the endoscopic endonasal approach in the treatment of these benign tumors.

Atypical sinonasal Schwannomas: A difficult diagnostic challenge

Objective Schwannomas are benign tumours arising from Schwann cells of the peripheral nerve sheath. They are relatively frequent in the head and neck region (25–45%) but rarely involve in the sinonasal tract (4%). The authors outline the diagnostic difficulties and the problems in choosing the best surgical approach in two atypical cases of sinonasal Schwannomas. Methods In the first case reported clinical data, sex and age of the patient, nasal endoscopy and angio-MRI led us to suspect an angiofibroma; therefore, we approached the case without a biopsy performing a preoperative selective embolization followed by an endoscopic resection. In the second case, due to initial visual symptoms and to the ethmoid-orbital compartment involvement, we performed a sinonasal endoscopy and collected a biopsy which resulted to be fundamental in the diagnostic assessment. Tumour excision was then obtained throughout an intracranial/endonasal approach. Results The two presented cases revealed the presence of cystic Schwannomas. In the first case, diagnosis was made only post-operatively after histological examination. Patients underwent complete surgical excision by means of an endoscopic sinonasal approach, in the second case associated to a left frontal craniotomy. The patients showed no signs of recurrence at a 9 months follow-up. Conclusions Nasal endoscopy was extremely important in making the diagnosis, allowing an accurate assessment of the tumour extension and a biopsy. The diagnosis of sinonasal Schwannomas remains challenging; sometimes, clinical behaviour and modern imaging may be misleading. The diagnostic and therapeutic importance of sinonasal endoscopy is emphasised in the two presented cases.