Abstract
Trigeminal schwannoma is a rare skull base tumor that can be managed in a variety
of treatments including image observation, surgery, stereotactic radiosurgery, such
as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal
resection is very effective when the tumor is not invading far laterally, or the risk
of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a
history of prostate cancer and diabetes presented with left oculomotor nerve palsy
over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left
cavernous sinus protruding to the left orbit via the superior orbital fissure ([Fig. 1]). The patient underwent endoscopic transnasal surgery to decompress the mass. The
surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection
of the mass ([Fig. 2]). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly
enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last
follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased
from the known prostate cancer. Endoscopic transnasal surgery was especially useful
in this case, considering the preoperative known cancer state that management of this
benign tumor did not ruin the quality of life of this patient while minimizing hospitalization,
as achieving satisfactory tumor control with aid from postoperative GKS, minimizing
complications.
The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w.
Keywords
endoscopic transnasal surgery - gamma knife radiosurgery - transsphenoid surgery -
trigeminal schwannoma
