TITLE:
Voluminous Cystic Trigeminal Schwannoma: Case Report and Literature Review
AUTHORS:
Médard Kakouc, Alban Slim Mbende, Romuald Kouitcheu, Fulbert Kouakou, Paulette Yapo, Isidore Diomandé
KEYWORDS:
Schwannoma, Cystic, Cavernous Sinus Syndrome, Trigeminal Nerve
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.7 No.4,
September
18,
2017
ABSTRACT: Voluminous trigeminal schwannomas are rare,
predominantly benign growth encapsulated tumors composed of Schwann cells with
controversial surgical treatment. They account for 20% to 40% of all trigeminal
schwannomas and share the same imaging findings of neurinomas elsewhere.
Surgery remains the treatment of choice for most lesions as long as complete
excision is feasible. A 35-year-old house wife complained of a 3-month history
of progressive right visual field impairment associated with headaches.
Neurological examination revealed a complete cavernous sinus syndrome. CT
scanning showed a voluminous cystic mass of the right parasellar compartment
extending to the optic nerve and the orbit. A concomitant MRI scan revealed
more exquisite anatomical details of the lesion. The patient benefitted from a
subsequent CT-angiography (not included) which excluded any vascular
abnormalities associated with the tumor. Surgical excision of the tumor was
warranted and the patient underwent surgery a few days after admission. A
pterional extradural-intradural approach combined with incision of the lateral
wall of the parasellar compartment via a standard frontotemporal craniotomy was
performed and pathological examination was in favor of a cystic trigeminal
schwannoma. Post-operative MRI showed a complete excision of the tumor. A
2-year follow-up yielded persistent right monocular blindness. Given this
typical appearance of this lesion indicative of both cisternal and parasellar
compartment extension, as well as the level of controversy surrounding surgical
treatment of these particular tumors; we sought to report this rare case of a
voluminous cystic trigeminal schwannoma and share our humble surgical
experience of dealing with these lesions. The patient was informed that
non-identifying information from the case would be submitted for publication,
and she provided consent.