Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 12479  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,103 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed1894    
    Printed35    
    Emailed0    
    PDF Downloaded47    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 2  |  Page : 222-224

Intracalvarial schwannoma: A case report with review of literature


1 Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
2 Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
3 Imaging Sciences and Interventional Radiolog, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Date of Submission19-Feb-2014
Date of Decision13-Mar-2014
Date of Acceptance06-Apr-2014
Date of Web Publication14-May-2014

Correspondence Address:
S. Sandhyamani
Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.132447

Rights and Permissions



How to cite this article:
Amita R, Sandhyamani S, Abraham M, Nair S, Praveen A, Kapilamoorthy TR. Intracalvarial schwannoma: A case report with review of literature. Neurol India 2014;62:222-4

How to cite this URL:
Amita R, Sandhyamani S, Abraham M, Nair S, Praveen A, Kapilamoorthy TR. Intracalvarial schwannoma: A case report with review of literature. Neurol India [serial online] 2014 [cited 2021 May 15];62:222-4. Available from: https://www.neurologyindia.com/text.asp?2014/62/2/222/132447


Sir,

Intraosseous schwannomas are rare accounting for less than 1% of primary bone tumors. Its occurrence within the skull bone is uncommon. Only seven cases of intracalvarial schwannoma have been reported in the literature, [1] this is probably the eight case.

A 41-year-old female presented with insidious onset intermittent parasthesia in right upper and lower limbs and left hemicranial headache of four years duration. She had two episodes of generalized tonic-clonic seizures during this period and was on anti-epileptic drugs. On examination, there were no neurological deficits. The X-ray skull showed an expansile lytic lesion in the left frontal region [Figure 1]a. On magnetic resonance imaging (MRI), it was seen as intradiploic-enhancing lesion, hypointense on T1 and hyperintense on T2 with evidence of calcification within. The inner and outer table around the lesion were sclerotic [Figure 1]b. Radiological diagnosis was hemangioma. The possibility of an intraosseous schwannoma was not considered at first because of the extreme rarity of this location. Intraoperatively, the tumor was soft, yellowish and seen arising from the diploic space, extending out of inner table on to the dura, but not infiltrating dura. Tumor was excised and acrylic cranioplasty was done. The postoperative period was uneventful. The lesion was nodular mass measuring 4.5 × 3.5 × 2 cm. Cut section was firm, gray-white glistening with areas of hemorrhage [Figure 2]a. Microscopy showed a neoplasm composed of spindle cells with wavy nuclei arranged in short fascicles [Figure 2]b with attempted verocay body formation. Areas of hyalinization, myxoid degeneration, thick-walled congested and thrombosed vessels and areas of hemorrhage were noted within the neoplasm. Cells were strongly and diffusely positive for vimentin and S100 [Figure 3], while negative for smooth muscle antigen (SMA) and epithelial membrane antigen (EMA). A diagnosis of Intraosseous schwannoma of the frontal bone was made after ruling out a smooth muscle and meningothelial neoplasm. Patient is doing well at 3-months follow-up.
Figure 1: (a) Skull radiograph shows an expansile lytic left frontal calvarial lesion. (b) MRI of brain shows left calvarial intradiploic enhancing lesion in the frontal bone

Click here to view
Figure 2: (a) Cut-section of nodular mass gray-white glistening with areas of hemorrhage (b) Microscopy of Schwannoma; (H and E, ×100)

Click here to view
Figure 3: (a) Diffuse positivity for S100 and (b) Diffuse positivity for vimentin (a and b, ×100)

Click here to view


Schwannoma was first described by Verocay who called it "neurinoma". [2] Mandible is the most common site of intraosseous schwannoma, followed by vertebrae and long bones. [2] Although, the head and neck region is one of the most common sites for schwannomas, intraosseous skull vault schwannomas are extremly rare. [1] [Table 1] summarises the reported seven cases of intraosseous schwannoma of skull vault along with the present case. [1],[2],[3] Schwannomas arise almost exclusively from sensory nerves, which may be the reason for rarity of intraosseous schwannomas; the density of sensory nerves within bone being very low. Another postulated origin is from schwann cells of the paravasal nerves, which travel with the nutrient arteries of bone. [1] A microsurgical intracapsular enucleation is the treatment of choice and a complete excision has a good prognosis due to the low recurrence rate and the rarity of malignant transformation. [4] Undetected microscopic deposits can result in recurrence. Radio surgery should be reserved for treatment of unresectable or residual tumors. [5]
Table 1: Reported cases of Intraosseous schwannoma involving the skull vault


Click here to view


 
  References Top

1.Goyal R, Saikia UN, Vashishta RK, Gulati G, Sharma RK. Intraosseous schwannoma of the frontal bone. Orthopedics 2008;31:281.  Back to cited text no. 1
    
2.Ersahin Y, Mutluer S, Damirtas E. Intraosseous neurinoma of the parietal bone. Childs Nerv Syst 2000;16:181-3.  Back to cited text no. 2
    
3.Celli P, Cervoni L, Colonnese C. Intraosseous schwannoma of the vault of the skull. Neurosurg Rev 1998;21:158-60.  Back to cited text no. 3
    
4.Ito S, Mandai T, Ishida K, Deguchi H, Hata T, Irei I, et al. Intraosseous schwannoma of the mandible: A case report. Kawasaki Med J 2009;35:249-52.  Back to cited text no. 4
    
5.Ramina R, Mattei TA, Sória MG, da Silva EB Jr, Leal AG, Neto MC, et al. Surgical management of trigeminal schwannomas. Neurosurg Focus 2008;25:E6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Solitary intraosseous schwannoma of the base and vault of the skull: a summary review of such unusual location
Fadoua Rais,Naoual Benhmidou,Ghizlane Rais,Fadila Kouhen,Khadija Bellahamou,Hasna Loughlimi,Abdelhak Maghous,Sanae Elmejjaoui,Hanan Elkacemi,Tayeb Kebdani,Noureddine Benjaafar
Clinical Sarcoma Research. 2015; 5(1): 6
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow