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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 5  |  Page : 548-549

Giant oculomotor nerve schwannoma presenting as a sellar and suprasellar mass with parasellar extension


Department of Neurosurgery, Shrirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India

Date of Submission29-Jul-2014
Date of Decision03-Oct-2014
Date of Acceptance03-Oct-2014
Date of Web Publication12-Nov-2014

Correspondence Address:
Satya Bhusan Senapati
Department of Neurosurgery, Shrirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.144459

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How to cite this article:
Senapati SB, Mishra SS, Das S, Parida DK. Giant oculomotor nerve schwannoma presenting as a sellar and suprasellar mass with parasellar extension. Neurol India 2014;62:548-9

How to cite this URL:
Senapati SB, Mishra SS, Das S, Parida DK. Giant oculomotor nerve schwannoma presenting as a sellar and suprasellar mass with parasellar extension. Neurol India [serial online] 2014 [cited 2019 Sep 19];62:548-9. Available from: http://www.neurologyindia.com/text.asp?2014/62/5/548/144459


Sir,

Schwannomas account for 7% of all intracranial tumors and commonly arise from the vestibulocochlear and trigeminal nerves. Schwannomas arising from the oculomotor nerve are very rare, except with neurofibromatosis. Approximately 40 cases of oculomotor nerve schwannomas have been described in the literature, of which 12 cases were large (≥2.5cm) [1],[2] tumors. This report presents a case of giant oculomotor nerve schwannoma.

A 24-year-old female complained of progressive diplopia, ptosis of left eye for 2 years. These complaints were overlooked by family members. For the last six months, she had developed gradual progressive visual loss of left eye followed by right eye. She also used to have generalized headache, vomiting and features suggesting hypo-function of pituitary gland. On examination, her visual acuity was figure counting at 1 meter distance in both the eyes with left oculomotor nerve palsy and bilateral optic atrophy. Magnetic resonance imaging (MRI) of brain revealed a large, enhancing mass (6.1 × 3.6 × 6.2 cm) with central necrosis involving sellar and suprasellar regions, extending into left middle cranial fossa [Figure 1] and [Figure 2]. Left pterional craniotomy and wide splitting of the Sylvian fissure for tumor access was carried out. A large encapsulated, white, firm, moderately vascular, multilobulated tumor was found with a necrotic yellowish central zone. Intratumoural decompression, followed by dissection of tumor in arachnoid plane carried out. Though the tumor was abutting internal carotid artery but arachnoid plain was well maintained, so dissecting out the tumor from carotid was easy. After substantial debulking of the mass, the third nerve appeared from the interpeduncular cistern as a bundle and ran straight into the base of the mass. Complete removal of the tumor was done [Figure 3]. Preservation of nerve was tried but could not be preserved and was sacrificed. Postoperatively, the patient developed complete third nerve paralysis on the left side. Histopathology and immunohistochemistry confirmed the diagnosis of schwannoma [Figure 4]. During one year follow-up, her hormonal status had improved without radiological evidence of recurrence.
Figure 1: An axial T1- and T2-weighted MRI scan showing (T1-hypointense and T2-hyperintense) sellar mass with left parasellar extension

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Figure 2: Coronal and sagittal gadolinium-enhanced contrast T1- weighted MRI scan showing the said enhancing mass with central area of hypointensity. The lesion was compressing the optic chiasma with ipsilateral carotid encasement

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Figure 3: Postoperative axial and coronal contrast CT scans showing a complete resection of the lesion

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Figure 4: Histopathology showing compact Antoni A and loose Antoni B tissue, supporting schwannoma

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Kovacs, [3] who in 1927, described an isolated oculomotor nerve schwannoma observed during an autopsy, was probably the first to report such a tumor. Celli et al[4] divided oculomotor cranial nerve schwannomas into three groups: (1) Cisternal, (2) cisternocavernous and (3) cavernous lesions. This classification was based on the preferred extension of these tumors. Our case belongs to the cisternal type. The explanation for this large tumor could be that the ventral cistern of the brainstem is a potential space where these slow-growing tumors expand to a large size before they produce symptoms. Preserving function of the third nerve in these large tumors can be a challenge (whether complete or partial resections done), as confirmed in previous reports. [5],[6]

 
 » References Top

1.
Saetia K, Larbcharoensub N, Wetchagama N.Oculomotor nerve schwannoma: A case report and review of the literature. J Med Assoc Thai 2011;94:1002-7.  Back to cited text no. 1
    
2.
Prabhu SS, Bruner JM. Large oculomotor schwannoma presenting as a parasellar mass: A case report and literature review. Surg Neurol Int 2010;1:15.  Back to cited text no. 2
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3.
Kovacs W. Ueber ein solitares neuinom des nervus oculomotorius. Zentralbl Allg Pathol 1927;40:518-22.  Back to cited text no. 3
    
4.
Celli P, Ferrante L, Acqui M, Mastronardi L, Fortuna A, Palma L. Neurinoma of the third, fourth, and sixth cranial nerves: A survey and report of a new fourth nerve case. Surg Neurol 1992;38:216-24.  Back to cited text no. 4
    
5.
Kachhara R, Nair S, Radhakrishnan VV. Oculomotor nerve neurinoma: Report of two cases. Acta Neurochir (Wien) 1998;140:1147-51.  Back to cited text no. 5
    
6.
Mehta VS, Singh RV, Misra NK, Choudhary C. Schwannoma of the oculomotor nerve. Br J Neurosurg 1990;4:69-72.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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