Anterior Cranial Fossa and Ethmoid Sinus Schwannoma: Case Report

• Published in: Journal of Neurological Surgery Part B: Skull Base Vol. 73; no. S 02
• Main Authors: Melada, A., Jurlina, D., Lupret, V.
• Format: Conference Proceeding Journal Article
• Language: English
• Published: 01.06.2012
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1314354

Objective: Schwannomas arise from the nerve sheaths of cranial nerves, most commonly from vestibular. They are rare in the region of anterior cranial fossa and ethmoid sinus, where they are very similar to meningeoma or neuroblastoma. A hypothesis on the possible origin of subfrontal schwannoma is that it is associated with meningeal branches of ethmoidal nerves. Patient and Method: A 45-year-old man suffered from right-sided headache and pain in his right eye; he had breathing problems, hyposmia, and nasal secretion. MRI showed hyperintense tumor occupying anterior cranial fossa, ethmoid sinus, and nasal cavity. In operation, we performed a bifrontal craniotomy with craniofacial resection. After opening the dura, an extra-axial tumor was exposed, occupying the frontal base and destroying the cribriform plate to the ethmoid sinus. The tumor was hypervascular, partly hard, partly necrotic. We successfully removed it in the arachnoid layer to the frontal lobe. An ENT surgeon entered to the ethmoidal sinus and excised the rest of the tumor in total. For closing the frontal defect, we used an internal lamina of frontal bone and pericranial flap using fibrin glue. In postoperative findings, there were no neurological deficits or CSF leaks. Control MRI showed extradural empyema, which we solved by transnasal transethmoidal evacuation and drainage with antibiotics therapy. After 3 months, MRI showed no residual or recurrent tumor. Histopathologic examination showed alternating areas of compact, elongated cells and fewer cellular areas (Antoni type B). Conclusion: Except for meningiomas and neuroblastomas of this area, we must include these tumors in the differential diagnosis.