Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction
Extracranial schwannomas of the cranial base affecting multiple compartments are infrequent lesions and extremely rare in young patients.We describe the case of a 16 year-old male who presented with progressive proptosis, visual disturbances and nasal obstruction on the right side. The patient had m...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-12-01
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| Series: | Interdisciplinary Neurosurgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751919301501 |
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| author | M. Peris-Celda J.R. Janus J.J. Van Gompel |
| author_facet | M. Peris-Celda J.R. Janus J.J. Van Gompel |
| author_sort | M. Peris-Celda |
| collection | DOAJ |
| description | Extracranial schwannomas of the cranial base affecting multiple compartments are infrequent lesions and extremely rare in young patients.We describe the case of a 16 year-old male who presented with progressive proptosis, visual disturbances and nasal obstruction on the right side. The patient had moderate proptosis on the right side, protrusion of the right malar prominence and mild hypoesthesia on V3 territory. Endonasal examination revealed a completely obstructed right nasal cavity. MRI demonstrated a large contrast-enhacing mass mainly extracranial affecting the infratemporal fossa, middle fossa, and parapharyngeal space, which collapsed the right maxillary sinus and medialized the lateral wall of the right nasal cavity. Preoperative angiography revealed moderate tumor vascularization originating from the external carotid artery and was successfully embolized. Surgery included transmaxillary endoscopic-assisted resection through a Caldwell-Luc approach and endoscopic endonasal approach for reconstruction. The patient had an intraoperative cerebrospinal fluid leak that was repaired with abdominal fat graft and nasoseptal flap. The patient had a favorable postoperative course with expected numbness in the V2 territory and was discharged on postoperative day 2. Postoperative MRI demonstrated complete resection of the tumor. The surgical pathology confirmed schwannoma.Trigeminal schwannomas form part of the differential diagnosis of large extracranial masses affecting the nasal cavity and paranasal sinuses. Especially in young male patients, preoperative angiogram is indicated, as their presentation and radiologic appearance can be very similar to juvenile nasoangiofibromas. Schwannomas usually present moderate vascularization on angiogram as compared to the highly vascularized nasoangiofibromas. Keywords: Trigeminal schwannoma, Giant tumor, Juvenile nasoangiofribroma, Skull base tumor, Nasoseptal flap |
| first_indexed | 2024-12-11T11:20:38Z |
| format | Article |
| id | doaj.art-d83bea86182743cd8c0052c7e2a811fc |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-11T11:20:38Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-d83bea86182743cd8c0052c7e2a811fc2022-12-22T01:09:11ZengElsevierInterdisciplinary Neurosurgery2214-75192019-12-0118Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstructionM. Peris-Celda0J.R. Janus1J.J. Van Gompel2Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA; Northeast Professor Rhoton Anatomy Laboratory, Albany Medical Center, Albany, NY, USA; Corresponding author at: Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester 55905, MN, USA.Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USADepartment of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USAExtracranial schwannomas of the cranial base affecting multiple compartments are infrequent lesions and extremely rare in young patients.We describe the case of a 16 year-old male who presented with progressive proptosis, visual disturbances and nasal obstruction on the right side. The patient had moderate proptosis on the right side, protrusion of the right malar prominence and mild hypoesthesia on V3 territory. Endonasal examination revealed a completely obstructed right nasal cavity. MRI demonstrated a large contrast-enhacing mass mainly extracranial affecting the infratemporal fossa, middle fossa, and parapharyngeal space, which collapsed the right maxillary sinus and medialized the lateral wall of the right nasal cavity. Preoperative angiography revealed moderate tumor vascularization originating from the external carotid artery and was successfully embolized. Surgery included transmaxillary endoscopic-assisted resection through a Caldwell-Luc approach and endoscopic endonasal approach for reconstruction. The patient had an intraoperative cerebrospinal fluid leak that was repaired with abdominal fat graft and nasoseptal flap. The patient had a favorable postoperative course with expected numbness in the V2 territory and was discharged on postoperative day 2. Postoperative MRI demonstrated complete resection of the tumor. The surgical pathology confirmed schwannoma.Trigeminal schwannomas form part of the differential diagnosis of large extracranial masses affecting the nasal cavity and paranasal sinuses. Especially in young male patients, preoperative angiogram is indicated, as their presentation and radiologic appearance can be very similar to juvenile nasoangiofibromas. Schwannomas usually present moderate vascularization on angiogram as compared to the highly vascularized nasoangiofibromas. Keywords: Trigeminal schwannoma, Giant tumor, Juvenile nasoangiofribroma, Skull base tumor, Nasoseptal flaphttp://www.sciencedirect.com/science/article/pii/S2214751919301501 |
| spellingShingle | M. Peris-Celda J.R. Janus J.J. Van Gompel Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction Interdisciplinary Neurosurgery |
| title | Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction |
| title_full | Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction |
| title_fullStr | Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction |
| title_full_unstemmed | Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction |
| title_short | Endoscopic-assisted transmaxillary resection of a giant V2 schwannoma presenting with proptosis and nasal obstruction |
| title_sort | endoscopic assisted transmaxillary resection of a giant v2 schwannoma presenting with proptosis and nasal obstruction |
| url | http://www.sciencedirect.com/science/article/pii/S2214751919301501 |
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