phenylephrine-hydrochloride and Neurilemmoma

Neurilemmoma is a benign tumor derived from the Schwann cells of the nerve sheath. The highest incidence of neurilemmoma occurs in the head and neck region; however, the nose and paranasal sinuses are rarely involved. Less than 4% of these tumors involve the nasal cavity and paranasal sinuses. To date, only six cases of nasal vestibule neurilemmoma have been reported.. Two patients (a 32-year-old man and a 42-year-old woman) visited our clinic with complaint of a lump in the left nasal vestibule.. Histopathological examination and immunohistochemical staining confirmed a neurilemmoma.. The mass was completely removed via an intranasal approach.. Neurilemmoma is easy to overlook because it occurs rarely in the nasal vestibule, but neurilemmoma needs to be considered as a differential diagnosis.

Topics: Adult; Diagnosis, Differential; Female; Humans; Male; Nasal Cavity; Neurilemmoma; Nose; Nose Neoplasms

We present a 60-year-old female diagnosed with a giant trigeminal tumor (5.2*6.4*8.2 cm) situated in the middle cranial fossa and nasopharyngeal area. The patient was operated on by endoscopic endonasal transmaxillary, transpterygoid and infratemporal approaches. Postoperatively she was stable, with no neurologic complication and no cerebrospinal fluid leakage. We review the literature on extremely large trigeminal schwannomas.

Topics: Cranial Nerve Neoplasms; Endoscopy; Female; Humans; Middle Aged; Nasopharynx; Neurilemmoma; Nose

The objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach.. The information of 4 patients diagnosed with TS who were surgically treated was retrospectively analyzed and the selection of approaches, surgical strategies, and potential reason for recurrence after middle fossa TS removal by EEA and interdural approach were discussed.. During last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University, among whom 1 patient with TS extending from middle fossa to infratemporal fossa was first treated by EEA, then the tumor recurred and the patient underwent a second operation via a frontotemporal subdural approach. During the second operation, we found part of tumor had broken through the dura mater into subdural space. Moreover, this phenomenon was detected in another 3 patients with middle-posterior fossa TS.. TS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.

Topics: Adult; Aged; Cranial Nerve Neoplasms; Dura Mater; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Nose; Subdural Space; Young Adult

The surgical management of trigeminal schwannomas (TNs) entails the use of a variety of cranial base approaches for their effective surgical management. Although an extended middle fossa or posterior petrosal approach may be more appropriate for disease with primarily posterior fossa involvement, the expanded endoscopic approaches are suited for tumors with predominately middle fossa and/or extracranial involvement along the V2 and V3 divisions and limited posterior fossa extension. The endoscopic endonasal resection of TNs within the middle fossa, pterygopalatine fossa, and infratemporal fossa is reviewed in this article with a brief discussion of reported outcomes.

Topics: Cranial Nerve Neoplasms; Humans; Natural Orifice Endoscopic Surgery; Neurilemmoma; Neuroendoscopy; Nose; Trigeminal Nerve Diseases

To describe four endoscopic endonasal subapproaches, namely, the trans-lamina papyracea, trans-prelacrimal recess, trans-Meckel's cave, and transclival approaches for trigeminal schwannomas (TSs).. This retrospective study reviewed the medical records and intraoperative videos of 38 patients with TSs who underwent endoscopic endonasal approach (EEA) between Jan 2013 and Dec 2021.. According to Jeong's classification, for TS equally in middle and posterior fossae (MP), a purely trans-Meckel's cave approach was carried out in 2 cases, and a combined transclival approach was carried out in 4 cases. The four tumors that involved infratemporal fossa (two E3, one mE3, and one Mpe3) were performed via a trans-prelacrimal recess approach, and type Mpe3 was also assisted by the trans-Meckel's cave approach. One patient with type E1 was treated with a trans-lamina papyracea approach. The other 27 cases, including type M, Mp, ME2, and MpE2, were all removed by a purely trans-Meckel's cave approach. Thirty-six patients (97.4%) received total resection under a purely EEA. The functional abilities and preoperative symptoms of 31 patients (88.6%) improved. Eight (21.1%) patients experienced permanent neurological function deficits. Postoperative cerebrospinal fluid and intraoperative internal carotid artery injury occurred in 1 (2.6%) patient.. According to the specific endoscopic endonasal subapproaches corresponding to the different TS locations, satisfactory results can be obtained for most types of tumors. It represents an effective alternative to the open transcranial approach and can also be properly used in most types of TS with experienced hands.. 4 Laryngoscope, 133:2564-2571, 2023.

Topics: Cranial Nerve Neoplasms; Endoscopy; Humans; Neurilemmoma; Nose; Retrospective Studies

Tumors of the retromaxillary tissues can grow to involve multiple deep, skull base spaces, including the pterygopalatine fossa, infratemporal fossa, and the parapharyngeal space. Management of these tumors must account for heterogeneous pathology as well as the critical neurovasculature in and surrounding these spaces. Traditionally, these tumors have been approached the open skull base or anterior craniofacial approaches. Modern endoscopic endonasal and multiport approaches have increasingly become favored for certain tumors in the retromaxillary skull base region. In this report, we present the case of a 42-year-old male presented with refractory headache and was found to have a left-sided 5.0 cm tumor of the retromaxillary spaces with widening of foramen ovale. Differential diagnosis included schwannoma of the mandibular nerve, paraganglioma, salivary gland tumor, or soft tissue tumor. The tumor was approached via an expanded endoscopic approach to the pterygopalatine fossa and augmented with a Caldwell-Luc maxillotomy, to access the posterolateral extent of the tumor. A 2-surgeon team utilized visualization and instrumentation through both the transnasal and transmaxillotomy corridors to completely mobilize and remove the tumor. Post-resection imaging demonstrated complete removal of the tumor and pathology confirmed the diagnosis of schwannoma. Custom, multiport surgery can be a safe, less invasive approach for successful management of well selected retromaxillary skull base tumors.

Topics: Adult; Endoscopy; Humans; Male; Neurilemmoma; Nose; Skull Base; Skull Base Neoplasms

Topics: Cranial Nerve Neoplasms; Humans; Neurilemmoma; Neuroendoscopy; Nose

Spindle cell-predominant trichodiscoma (SCPT) is a benign adnexal neoplasm, best categorized within the trichodiscoma-fibrofolliculoma continuum. SCPTs clinically present as dome-shaped papules usually on the face, particularly on the nose or the nasolabial fold. The SCPT variant has been described as a particularly cellular trichodiscoma composed of small interweaving fascicles and sheets of spindle cells. Identical lesions were previously referred to as neurofollicular hamartomas because of their predominantly fascicular stromal cellularity and focal S100 positivity. In this article, we report a rare variant of SCPT with a palisaded arrangement. The patient is a middle-aged man with no significant dermatologic history who presented with a skin-colored papule on the left nasal ala. It had been present for approximately 10 years with only minimal growth over that time. A biopsy was obtained. Histopathological analysis revealed a dermal papule composed of bland spindle cells arranged in a striking palisading pattern within a fibromyxoid stroma with associated peripheral hyperplasia of sebaceous glands. The palisaded pattern shared features reminiscent of Verocay bodies of a schwannoma. Immunohistochemical studies revealed stromal spindled cells with a strong and diffuse pattern of CD34 expression and absent S100 and SOX10 expressions. To our knowledge, only 2 cases of SCPT with a palisaded pattern have been presented. SCPT with a palisaded pattern is a rare histopathologic variant that may resemble a schwannoma but can be recognized by its strong epithelial components and immunohistochemical staining pattern.

Topics: Hair Diseases; Humans; Male; Middle Aged; Neurilemmoma; Nose; Sebaceous Glands; Skin Neoplasms

Non-vestibular schwannomas (NVSs) of the skull base occur in several sites, and few previous studies have evaluated the usefulness of the endoscopic endonasal transmaxillary-pterygoid approach (EETMPA) to resect these lesions. We aimed to evaluate the characteristics and clinical outcomes of patients who underwent EETMPA for skull-base NVSs and to investigate the efficacy, safety, and indications for the procedure.. We retrospectively reviewed the clinical data of 10 consecutive patients (mean age, 45 ± 17) who underwent EETMPA for skull-base NVSs at the University of Tsukuba hospital between 2013 and 2020. We also calculated the total tumor volume and the size of the corridor to the tumor for EEA (SCEEA) in nine patients who underwent EEA for NVSs adjacent to the Meckel's cave or cavernous sinus.. Nine patients (9/10), including five women (5/10), underwent primary surgery. Gross total resection and subtotal resection were achieved in five patients each (5/10). Postoperatively, one patient showed a new and mild cranial nerve V sensory deficit and one patient showed slight worsening of abducens nerve palsy. The greater palatine nerve was amputated in two patients; however, permanent perception loss in the soft palate was observed in one patient. The Vidian nerve was sacrificed in four patients, and new dry eye occurred in one patient. None of the patients experienced postoperative tumor recurrence or regrowth during the follow-up period of 40 ± 28 months.. EETMPA is safe and effective for excising skull-base NVSs which are not eligible for radiosurgery leading to a high rate of successful resection and a high rate of but mild neurological sequela. The EEA is appropriate when the tumor extends to the paranasal sinus with sufficient SCEEA.

Topics: Adult; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Nose; Retrospective Studies; Skull Base; Skull Base Neoplasms

An anteromedial corridor via an expanded endoscopic endonasal approach to the Meckel cave (MC) was described more than a decade ago. However, few clinical series or endoscopic endonasal technical contributions exist concerning this type of approach to this complex region.. We present a detailed description of the surgical technique for this approach reviewing the original technique and adding clarifying conceptual notions. We conducted a multicenter retrospective study selecting patients who underwent endonasal endoscopic surgery for lesions exclusively limited to the MC in the past 6 years. Intraoperative and postoperative complications were analyzed. The study of 10 cadaveric specimens provides additional information.. We performed a fully endoscopic anteromedial corridor to the MC in 18 patients. The most prevalent pathologic finding was schwannoma of the V nerve in 4 patients. Sixth cranial nerve palsy (13 patients) and trigeminal dysfunction (10 patients) were the predominant preoperative clinical signs. There were no remarkable intraoperative complications. Corneal keratopathy caused by dry eye syndrome affected 3 patients and V2 residual neuralgia appeared postoperatively in 2 patients. Six patients recovered from sixth cranial nerve palsy, and 2 showed improvement in preoperatively referred facial pain.. The front door to the MC via the endonasal anteromedial corridor could be a good option. Understanding of the anatomy and the concept of the quadrangular space is crucial to performing this technique safely, which has few complications in experienced hands. Recovery from sixth nerve palsy is possible with this approach. Corneal keratopathy in these patients is a potential complication.

Topics: Abducens Nerve Diseases; Endoscopy; Humans; Neurilemmoma; Nose; Retrospective Studies

Trigeminal schwannomas (TSs) with solitary extracranial location are rare, and surgical excision is challenging. In recent years, the endoscopic endonasal transmaxillary transpterygoid approach (EETPA) has been advocated as an effective strategy for TSs in the infratemporal fossa (ITF).. We describe the steps of the EETPA combined with the sublabial transmaxillary approach for the surgical excision of a giant mandibular schwannoma of the ITF. Indications, advantages, and approach-specific complications are also discussed. The main surgical steps are shown in an operative video.. A combined EETPA and sublabial transmaxillary approach represents a safe and effective option for the surgical excision of extracranial TSs.

Topics: Cranial Nerve Neoplasms; Endoscopy; Humans; Infratemporal Fossa; Neurilemmoma; Nose

Topics: Cranial Nerve Neoplasms; Humans; Neurilemmoma; Nose

Topics: Cranial Nerve Neoplasms; Humans; Neurilemmoma; Nose

Topics: Cranial Nerve Neoplasms; Humans; Neurilemmoma; Nose

Orbital schwannomas are a rare disease, representing about 1% of orbital tumors, potentially involving any subsite within the orbit. They usually present with painless, nonpulsatile proptosis, while diplopia and vision impairment due to extrinsic ocular muscles or optic nerve involvement are rarely observed.

Topics: Female; Humans; Natural Orifice Endoscopic Surgery; Neurilemmoma; Neuroendoscopy; Nose; Orbital Neoplasms; Young Adult

Neurinomas in the nose and the nasal sinuses are rare. In the present work, we present an exceedingly rare case of a disfiguring neurinoma involving the nasal columella. Treatment of choice is complete resection of the tumor. For an optimal view for tumor resection and esthetic and functional reconstruction, we recommend an open surgical approach.

Topics: Cochlea; Esthetics; Humans; Nasal Septum; Neurilemmoma; Nose; Rhinoplasty

Topics: Adolescent; Humans; Male; Nasal Obstruction; Neurilemmoma; Nose; Nose Neoplasms

Trigeminal schwannomas are benign slow-growing tumors originating from the peripheral nerve sheath. They account for 0.1%-0.4% of all intracranial tumors and 1%-8% of all intracranial schwannomas.

Topics: Adult; Cranial Nerve Neoplasms; Female; Humans; Magnetic Resonance Imaging; Neurilemmoma; Neuroendoscopy; Nose; Pterygopalatine Fossa; Trigeminal Nerve

The anatomical locations involved in trigeminal schwannomas (TSs) are quite complex. The endoscopic endonasal approach provides a minimal damage access corridor to both anterior and middle skull base for surgery. Given the nerve function recovery and postoperative neurological deterioration varied in different reports, the author demonstrates his surgery tips and the functional outcomes under endoscopic surgery in one single institution.. A retrospective review of patients with TSs was undertaken to assess the outcome of endoscopic surgery from 2006 to 2016. Clinical features, imaging findings, preoperative/postoperative neurological deficits, surgical approaches and followed up data were collected.. Thirty-nine patients with TSs were included in this study. Surgical approaches include endoscopic medial maxillectomy approach (n = 8), endoscopic endonasal-assisted sublabial transmaxillary approach (n = 27) and endoscopic endonasal-assisted sublabial transmaxillary combined with septectomy (n = 4). Gross total resection and sub-total resection were achieved in 27 and 10 patients, respectively. The most common chief complaint was facial numbness, accounting for 41%, with a resolved rate of 62.5% after treatment. Fifteen patients developed new neurologic symptoms, including facial numbness/pain (n = 9 and 2, respectively), dry eye (n = 3) and mastication weakness (n = 1). Eight of these patients had partial improvement except for patients with dry eye.. Endoscopic endonasal approach represents a safe and effective surgical procedure for TSs in pterygopalatine fossa, infratemporal fossa and even Meckel cave. Tumor resection can be achieved by endoscope with few neurologic deficits and complications.

Topics: Adult; Aged; Endoscopy; Female; Humans; Male; Maxilla; Middle Aged; Neurilemmoma; Nose; Postoperative Complications; Retrospective Studies; Skull Neoplasms

Topics: Adult; Aged; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; China; Cranial Nerve Neoplasms; Endoscopes; Endoscopy; Female; Humans; Male; Middle Aged; Neurilemmoma; Nose; Nose Neoplasms; Pterygopalatine Fossa; Retrospective Studies; Skull Base Neoplasms; Surgical Flaps; Treatment Outcome; Trigeminal Nerve Diseases

Primary watertight dural closure is the preferred method of postcraniotomy dural repair. However, even when ideal technique is implemented, postoperative infection, cerebrospinal fluid (CSF) leaks, pseudomeningoceles, and dural scarring are possible complications. For this reason, materials that augment the dura's ability to create a watertight seal, prevent disease transmission, and inhibit inflammatory response are sought. Dehydrated amniotic membrane (DAM) allograft appears to fulfil these requirements as it has several beneficial properties that aid wound healing, including promotion of epithelialization, scar tissue prevention, and inhibition of bacterial growth. We provide the literature's first description of the use of DAM allograft to supplement dural closures for craniotomies and transsphenoidal surgeries.. We conducted a pilot study, retrospectively reviewing our institution's database of craniotomies and transsphenoidal surgeries that utilized DAM to augment dural closure.. One hundred fifty-five cases, including 102 new craniotomies for supratentorial lesions, one re-do craniotomy for supratentorial recurrent glioma, 18 craniotomies for infratentorial lesions, 1 craniotomy for anterior skull base schwannoma, 32 transphenoidal surgeries, and 1 combined craniotomy and transnasal endoscopic surgery, used DAM allograft to augment dural closure. Only one complication occurred (0.6% complication rate), which was a superficial wound infection requiring washout without craniectomy. No CSF leaks occurred.. This pilot study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during dural closures for craniotomies and transsphenoidal surgeries.

Topics: Adult; Aged; Aged, 80 and over; Allografts; Amnion; Brain Neoplasms; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Craniotomy; Dura Mater; Endoscopy; Female; Glioma; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Nose; Pilot Projects; Postoperative Complications; Reoperation; Retrospective Studies; Skull Base Neoplasms; Supratentorial Neoplasms; Wound Closure Techniques; Young Adult

Topics: Humans; Neoplasm Recurrence, Local; Neurilemmoma; Nose; Nose Neoplasms; Prognosis; S100 Proteins

Skull base lesions are challenging to treat and may be managed using several approaches each with its own advantages and limitations. In selected cases, a modular, combined, multiportal approach could overcome the limits of a single approach and respond well to the needs of the patient.. We report a preclinical study on 5 cadaveric specimens and 4 preliminary clinical experiences with the combined multiportal transnasal transorbital endoscopic approach for the management of selected complex skull base pathologies. The technical feasibility and safety of this combined approach were evaluated in the preclinical study. The applicability in vivo of such an approach, together with early and late complications, specific morbidity, and hospitalization time were analyzed in the preliminary clinical experiences.. The transnasal endoscopic extended approach combined with the transorbital endoscopic approach offered greater visualization and tissue handling than a single approach alone could. The multiportal combined transorbital transnasal endoscopic approach was used effectively in vivo to resect 1 case of malignant schwannoma arising from the second branch of the trigeminal nerve and 3 cases of spheno-orbital meningioma without significant complications and with minimal morbidity for the patients.. The multiportal combined transorbital transnasal endoscopic approach is a safe and effective procedure for management of selected complex skull base lesions that is able to capitalize on the advantages and overcome the limitations of each single approach. This combined approach offers a multiperspective view of the spaces and allows for a more synergized procedure, especially when dealing with multicompartmental lesions.

Topics: Adult; Aged; Cadaver; Cranial Nerve Neoplasms; Feasibility Studies; Female; Follow-Up Studies; Humans; Length of Stay; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Natural Orifice Endoscopic Surgery; Neurilemmoma; Neuroendoscopy; Nose; Orbit; Treatment Outcome; Trigeminal Nerve Diseases

In recent years, application of endoscopic transnasal surgery (ETS) has been expanded to orbital lesions, and preliminary results have started to be published for medially located soft mass lesions. However, reports on experience with endoscopic intraorbital surgery aimed at resection of invasive skull base tumors remains quite limited. This report presents the authors' experience with ETS for locally aggressive tumors involving the orbit.. ETS was performed for 15 cases of aggressive tumors involving the orbit: 5 meningiomas (meningothelial, n = 3; atypical, n = 1; anaplastic, n = 1), 4 chordomas, 2 chondrosarcomas, and 4 others (metastasis from systemic myxofibrosarcoma, schwannoma, inverted papilloma, and acinic cell carcinoma, n = 1 each). Among these, 9 tumors were located outside the periorbita and 6 inside the periorbita. In 6 intraperiosteal tumors, 5 were intraconal lesions, of which 3 arose in the muscle cone (anaplastic meningioma, optic sheath meningioma, and metastatic myxofibrosarcoma), and 2 meningothelial meningioma had invaded from the sphenoid ridge or the cavernous sinus into the muscle cone through the optic canal and the superior orbital fissure. A case of schwannoma originated around the cavernous sinus and pterygopalatine fossa and extended extraconally into the periorbita. Intraoperatively, ethmoid air cells and the lamina papyracea were removed, and extraperiosteal tumors were safely approached. For intraperiosteal tumors, the periorbita was widely opened, and the tumors were approached through the surgical window between the rectus and oblique muscles.. Gross-total resection was achieved for 12 of the 15 tumors, including 2 intraconal lesions. After surgery, exophthalmos resolved in all 8 patients with this symptom, and diplopia resolved in 5 of 6 patients. Improvement of visual symptoms was reported by 4 of 5 patients with loss of visual acuity or constriction of the visual field. Postoperatively, 1 patient showed mild, transient worsening of existing facial dysesthesia, and another showed transient ptosis and mild hypesthesia of the forehead on the affected side. All those symptoms resolved within 3 months. No patients showed enophthalmos, worsening of diplopia or visual function, or impairment of olfaction after surgery.. ETS appears acceptable as a less-invasive alternative for treating aggressive tumors involving the orbit. For extraperiosteal tumors, gross-total removal can generally be achieved without neurological complications. For intraperiosteal tumors, surgical indications should be carefully discussed, considering the relationship between the tumor and normal anatomy. Wide opening of the periorbital window is advocated to create a sufficient surgical pathway between the extraocular muscles, allowing a balance between functional preservation and successful tumor resection.

Topics: Adult; Aged; Aged, 80 and over; Chondrosarcoma; Chordoma; Female; Humans; Male; Meningioma; Middle Aged; Natural Orifice Endoscopic Surgery; Neurilemmoma; Nose; Orbital Neoplasms; Treatment Outcome

Resection of the cavernous sinus (CS) lesions has been a surgical challenge because the anatomy of the CS presents a high grade of complexity. This report describes the feasibility of the purely endoscopic endonasal approach to the CS. Twenty-five patients with intracavernous sinus tumors were treated with a purely endoscopic endonasal approach. The indications, efficacy, surgical techniques, and complications of this approach were discussed. Gross total resection occurred in 19 cases (76%), subtotal resection occurred in 2 cases (8%), and partial resection occurred in 4 cases (16%) including pituitary adenoma in 10 cases (total 70%; subtotal 10%; partial 20%), meningioma in 6 cases (total 66.6%; subtotal 16.7%, partial 16.7%), schwannoma in 5 cases (100%, total 5), malignant tumor in 4 cases (total 75%; subtotal 25%). All patients experienced resolution or improvement of symptoms. No patient experienced intraoperative complication and new neurological deficit. Only 1 case of postoperative cerebrospinal fluid leakage repaired via endoscopic endonasal approach on the 14th day after the surgery. The purely endoscopic endonasal approach to the CS in appropriately evaluated patients can be used to address a wide variety of benign and malignant tumor pathology with favorable outcomes and a low incidence of complications.

Topics: Adenoma; Adult; Aged; Cavernous Sinus; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Maxillary Sinus; Meningeal Neoplasms; Meningioma; Middle Aged; Natural Orifice Endoscopic Surgery; Neurilemmoma; Neurosurgical Procedures; Nose; Pituitary Neoplasms; Postoperative Complications; Skull Base Neoplasms; Treatment Outcome; Young Adult

Because multiple anatomical compartments are involved, the surgical management of trigeminal schwannomas requires a spectrum of cranial base approaches. The endoscopic endonasal approach to Meckel's cave provides a minimal access corridor for surgery, but few reports have assessed outcomes of the procedure or provided guidelines for case selection.. A prospectively acquired database of 680 endoscopic endonasal cases was queried for trigeminal schwannoma cases. Clinical charts, radiographic images, and long-term outcomes were reviewed to determine outcome and success in removing tumor from each compartment traversed by the trigeminal nerve.. Four patients had undergone endoscopic resection of trigeminal schwannomas via the transpterygoid approach (mean follow-up 37 months). All patients had disease within Meckel's cave, and 1 patient had extension into the posterior fossa. Gross-total resection was achieved in 3 patients whose tumors were purely extracranial. One patient with combined Meckel's cave and posterior fossa tumor had complete resection of the extracranial disease and 52% resection of the posterior fossa disease. One patient with posterior fossa disease experienced a sixth cranial nerve palsy in addition to a corneal keratopathy from worsened trigeminal neuropathy. There were no CSF leaks. Over the course of the study, 1 patient with subtotal resection required subsequent stereotactic radiosurgery for disease progression within the posterior fossa.. Endoscopic endonasal approaches appear to be well suited for trigeminal schwannomas restricted to Meckel's cave and/or extracranial segments of the nerve. Lateral transcranial skull base approaches should be considered for patients with posterior fossa disease. Further multiinstitutional studies will be necessary for adequate power to help determine relative indications between endoscopic and transcranial skull base approaches.

Topics: Adult; Cranial Nerve Neoplasms; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Nose; Prospective Studies; Retrospective Studies; Trigeminal Nerve

Topics: Humans; Neurilemmoma; Nose; Nose Neoplasms

Extracranial trigeminal schwannomas extending into the infratemporal fossa are rare. The traditional surgical approaches to the infratemporal fossa are associated with complications, such as facial nerve dysfunction, hearing loss, dental malocclusion and cosmetic problems. We report eight patients (four males, four females, age range=31-62 years) who were treated between 2004 and 2009 for extracranial trigeminal schwannomas extending into the infratemporal fossa. Schwannomas were surgically removed using a purely endoscopic endonasal approach. The maximum diameters of the tumours ranged from 30 mm to 70 mm and all tumours were completely removed. There were no intraoperative or postoperative complications in this series. There were no recurrences during the follow-up period which ranged from 10 to 74 months (mean=30 months). The purely endoscopic endonasal approach may provide a minimally invasive and safe approach to remove extracranial trigeminal schwannomas extending into the infratemporal fossa. Radical resection was associated with an excellent long-term outcome in this series.

Topics: Adult; Cranial Nerve Neoplasms; Endoscopy; Female; Follow-Up Studies; Frontal Bone; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Nose; Retrospective Studies; Temporal Bone

Schwannomas are rare tumours arising from the peripheral nerve sheath. Nearly half of all schwannomas occur in the head and neck region, but the sinonasal tract is rarely involved. We report on an extremely rare case of vidian nerve schwannoma accompanied by mucopyocele with symptoms of oculomotor palsy and CSF leakage. An exclusively endoscopic endonasal approach was performed to excise the tumour and the dural defect was repaired. To our knowledge, this is the first time a vidian nerve schwannoma has been excised in an exclusively endoscopic approach. We first review the literature and then discuss the benefits for patients undergoing this type of operation.

Topics: Aged; Cranial Nerve Neoplasms; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Mucocele; Natural Orifice Endoscopic Surgery; Neurilemmoma; Nose; Ophthalmoplegia; Sphenoid Bone; Tomography, X-Ray Computed

Schwannoma is a neurogenic neoplasm rarely found in the sinonasal tract. It is a benign tumor arising from the sheath of myelinated nerve fibers that may occur in any part of the body. Its diagnosis and treatment can pose certain challenges.. A 35-year-old woman presented to the senior surgeon with a nasal tip tumor that had been developing for almost 10 years. Ultrasound showed edema of the nose because of multiple solid nodes. The computed tomography (CT) scan did not show invasion of the bony framework around the tumor (maxilla, septum, nasal bones). Magnetic resonance imaging (MRI) showed a deviation of the septum and well-defined round nodes at the nasal tip with a thick layer of skin around them. Resection of the tumor was performed using open rhinoplasty.. The limits of the excision were free of tumor, and histologic analysis of the tumor showed the characteristics of a schwannoma. At this writing, 2 years postoperatively, the patient is free of recurrence.. Schwannoma of the nasal tip is a benign tumor that gradually causes aesthetic and functional disorders. Radiologic examinations can assist in its diagnosis. The treatment is surgical excision and histologic analysis of the specimen.

Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Neurilemmoma; Nose; Nose Neoplasms; Rhinoplasty; Tomography, X-Ray Computed

To investigate the feasibility of removing extracranial trigeminal schwannomas located in the infratemporal fossa by using a purely endoscopic endonasal approach.. From November 2004 to July 2009, 8 patients with extracranial trigeminal schwannomas located in the infratemporal fossa (4 male patients and 4 female patients, age ranged 31 - 62 years) were surgically treated by using a purely endoscopic endonasal approach.. The maximum diameters of the tumors ranged from 3 to 7 cm. All tumors were completely removed. The operation time was 40 to 120 min, blood loss was 300 to 1500 ml. The clinical symptoms of some patients were relieved or improved. There were no intraoperative and postoperative complications, no deaths in this series. No relapse happened during the follow-up.. The purely endoscopic endonasal approach may provide a minimally invasive and safe approach to remove extracranial trigeminal schwannomas extending into the infratemporal fossa. Radical resection is associated with an excellent long-term outcome in this series.

Topics: Adult; Endoscopy; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurilemmoma; Nose; Trigeminal Nerve

Patients with advanced skin cancer present a unique challenge to neurosurgeons. Treatment involves aggressive surgical intervention and lengthy reconstructive procedures with considerable morbidity to obtain adequate and safe oncological margins. We reviewed our experience with BioGlue Surgical Adhesive, a protein-based adhesive, as an adjunct in free tissue transfer procedures to prevent CSF leakage and seroma formation.. Between January 2000 and June 2004, 11 patients ranging in age from 32 to 87 years presented with advanced skin cancer tumors in the head and neck. Pathology included squamous (7) and basal (3) cell carcinoma and malignant schwannoma (1). Of the 11 patients, 8 had undergone previous surgery and/or radiation therapy. All were treated with a combination of craniotomy, skull base, and craniofacial approaches with reconstruction of the large defects using muscular or myocutaneous free flaps in a single operation. Fat, muscle, and a 1-mm epidural layer of BioGlue were used to seal the dural sutures and to obliterate any potential seroma-forming dead space.. A total of 6 patients underwent craniofacial resection with orbital exenteration and partial rhinectomy, whereas the remaining 5 underwent frontal, parietal, and/or occipital craniotomies. All patients required dural repair. Three patients required additional brain resection because of tumor infiltration. No patient developed a CSF leak or seroma. There were no adverse events related to the use of BioGlue. Three patients died of medical complications (pulmonary embolism, myocardial infarction, late-onset myelodysplasia). The remaining patients are alive, and our follow-up (range, 9-58 months) has revealed no recurrence or distal metastasis.. Advanced skin cancer tumors in the head and neck region are associated with complex and disfiguring surgical procedures with increased morbidity. We demonstrate that an adjunctive use of a sufficiently strong tissue adhesive can yield acceptable outcomes and minimize comorbidity in this challenging patient population.

Topics: Adult; Aged; Aged, 80 and over; Brain; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Craniotomy; Dura Mater; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Neurilemmoma; Neurosurgical Procedures; Nose; Orbit; Plastic Surgery Procedures; Postoperative Complications; Proteins; Skin Neoplasms; Tissue Adhesives

We report 2 cases of nasolabial cyst and a case of schwannoma beneath the alar base that required a differential diagnosis because of clinical features and MR images that resembled the nasolabial cyst. The morphologic analysis on MR images revealed the characteristic appearance of the nasolabial cyst, and the sagittal MR image may be most helpful for diagnosing this rare disease.

Topics: Adolescent; Connective Tissue; Cysts; Female; Humans; Lip; Lip Neoplasms; Male; Middle Aged; Neurilemmoma; Nose; Nose Neoplasms; Soft Tissue Neoplasms

Topics: Adult; Humans; Magnetic Resonance Imaging; Male; Neurilemmoma; Nose; Nose Neoplasms; Rhinoplasty

We report a schwannoma with a rare location at the tip of the nose in a 20-year-old woman with an otherwise unremarkable medical history. The imaging findings underline the usefulness of MRI in narrowing down the differential diagnosis of masses in this region. Once the diagnosis was focussed on a neural origin of the mass, the exact nature of the tumour could not be predicted from the MRI, although the presence of a capsule on imaging studies as well as at operation suggested it was probably a schwannoma. A schwannoma must be considered when one encounters a sharply delineated mass at the tip of the nose, showing high signal on T2-weighted images and strongly contrast enhancement.

Topics: Adult; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Neurilemmoma; Nose; Nose Neoplasms; Rhinoplasty

Midfacial degloving can be characterized as an alternative surgical approach for exposing the bony structures of the midface. In combination with transient partial osteotomies the nasal cavities, the paranasal sinuses, the pterygopalatine fossa and the posterior parts of the anterior skull base are easily accessible. Using an intercartilaginous, a transseptal and a circumvestibular incision in the nose and a vestibular incision in the oral cavity the soft tissues of the upper face are mobilized and transposed cranially up to the infraorbital rim, the nasion and the lacrimal sac. Thus one can avoid scar formations in the face. In comparison with the common visible incisions in the face a bilateral exposure of midline structures is possible. The resected bone can be easily replaced and fixed with titanium miniplates for osteosynthesis. The soft tissue glove is replaced. A correct suture technique for readaptation especially in the nasal cavity is most important to avoid a circular stenosis of the nasal aperture. Between 1986 and 1991, 40 patients with various tumors (juvenile angiofibroma, inverted papilloma, esthesioneuroblastoma, squamous cell carcinoma of the maxillary sinus, benign tumors of the pterygopalatine fossa, clivus chordoma) underwent this procedure. Neoplasms and fractures of the anterior frontal skull base, the frontal sinus, the orbital cavity and the zygoma were less accessible due to the unsatisfactory exposure of these regions. Complications and side effects were rare. In five cases, a transient paresthesia of the infraorbital nerve and a facial edema were observed. In one case, a circular stenosis of the nasal aperture required a second plastic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenoma; Carcinoma; Fibroma; Hemangioma; Humans; Melanoma; Neoplasm Staging; Neurilemmoma; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Plasmacytoma; Postoperative Complications; Precancerous Conditions

Various surgical approaches to the region are discussed, and the procedure according to Hernandez Altemir (1986) described in detail. Six cases are presented to illustrate how this versatile osteoplastic technique may be adapted for individual patients.

Topics: Adenocarcinoma; Adenoma, Pleomorphic; Adolescent; Adult; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Ethmoid Bone; Face; Female; Head and Neck Neoplasms; Histiocytoma, Benign Fibrous; Humans; Male; Maxilla; Middle Aged; Neoplasms, Multiple Primary; Neurilemmoma; Nose; Nose Neoplasms; Osteoma; Osteotomy; Palatal Neoplasms; Pharynx; Skull Neoplasms

Topics: Histiocytoma, Benign Fibrous; Humans; Masticatory Muscles; Nasopharyngeal Neoplasms; Nasopharynx; Neurilemmoma; Nose; Paranasal Sinuses; Parotid Neoplasms; Pterygoid Muscles; Sinusitis; Tomography, X-Ray Computed

In a study of non-epithelial tumors involving the nasal cavity, paranasal sinuses and nasopharynx, 256 lesions, 156 benign and 100 malignant, were identified. Of these, six were classified as myxoma. Myxomas of facial bones, neoplasms of uncertain histogenesis, infiltrate adjacent tissues and if not completely excised will recur locally. In this series, three patients at one time were treated with limited local excisions. Tumor persisted or recurred in all three. Five patients were treated with en bloc resection (following recurrences in two patients). None of these patients subsequently developed recurrent tumor. We believe that myxomas should be widely resected to prevent recurrence. The extent of the surgical resection should depend on the size, extent and location of the lesion.

Topics: Adolescent; Adult; Child; Diagnosis, Differential; Female; Humans; In Vitro Techniques; Liposarcoma; Maxillary Neoplasms; Maxillary Sinus; Middle Aged; Myxoma; Nasal Cavity; Nasopharyngeal Neoplasms; Neoplasm Recurrence, Local; Neurilemmoma; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Rhabdomyosarcoma

An unusual presentation and treatment of an intranasal Schwannoma are discussed. The clinical and pathological features are also reviewed.

Topics: Humans; Middle Aged; Nasal Polyps; Nasopharyngeal Neoplasms; Neurilemmoma; Nose; Palate; Turbinates

Topics: Adult; Biopsy; Female; Humans; Neurilemmoma; Nose; Nose Neoplasms; Peripheral Nervous System Neoplasms

Topics: Humans; Nasal Septum; Neurilemmoma; Nose; Nose Neoplasms; Skin

Topics: Eyelid Neoplasms; Humans; Medical Records; Neurilemmoma; Neurofibromatoses; Neurofibromatosis 1; Nose

Topics: Humans; Medical Records; Neurilemmoma; Nose; Nose Neoplasms

Topics: Humans; Nerve Sheath Neoplasms; Neurilemmoma; Nose; Nose Neoplasms

Topics: Humans; Nasal Cavity; Neoplasms; Neurilemmoma; Nose; Paranasal Sinus Neoplasms

Topics: Humans; Nasal Cavity; Neoplasms; Neurilemmoma; Nose; Nose Neoplasms; Paranasal Sinuses