Schwannoma of the Sinonasal Tract and the Pterygopalatine Fossa with or without Intracranial Extension

Abstract

Aims: Compared with those in other head and neck regions, schwannomas in the nasal cavity or paranasal sinuses are rare. The aim of this study was to present the experience of the authors in 11 schwannoma cases of the sinonasal tract and pterygopalatine fossa over a decade. Methods: A retrospective study from 2003 to 2014. Results: Three female and 8 male patients from 22 to 61 years of age (mean age 42 years) were admitted. The most common complaints were unilateral nasal congestion. A total of 10 of the patients received surgery, including 6 functional endoscopic sinus surgeries (FESS). The postoperative course was generally uneventful. Among the patients, 10 remained regionally asymptomatic, and there has been no clinical or radiological evidence of recurrence or residual tumor. Conclusion: Surgical treatment is effective for schwannomas of the sinonasal tract and the pterygopalatine fossa with a low recurrence rate. Conducting CT and MRI (particularly fluid-attenuated inversion recovery) before surgery is mandatory. FESS could become the primary treatment of choice.

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas

“…Although the potential for malignant transformation of benign schwannomas has been described in other sites of the human body, only 2 cases of malignant degeneration of a benign sinonasal schwannoma have been reported in literature . To note, in our series, none of the patients presented malignant features on the final histologic report.…”

“…In 2012, Kim et al reported the largest radiological case series published to date, dealing with 12 cases of sinonasal schwannomas treated at 2 tertiary care Institutions. Others smaller series have been described previously in the literature (Table ) . We have treated a total of 11 patients with sinonasal schwannomas and, to the best of our knowledge, this is the largest series from a single institution focusing on the role of the endoscopic approach for the treatment of these tumors.…”

“…This experience has guided some authors to also approach sinonasal and skull base schwannomas endoscopically. At present, only a limited number of endoscopically treated cases (39 patients) has been reported in literature . For appropriate treatment, only a complete surgical resection of schwannomas can be considered curative because they may recur locally requiring further local resection if not excised properly .…”

“…The actual contraindications for the resection of sinonasal schwannomas through an endoscopic endonasal approach are as follows: (1) massive involvement of the frontal sinus; (2) concomitant presence of a malignant degeneration involving critical areas (frontal sinus, orbit, lacrimal pathways, and optic nerve); (3) massive intracranial intradural involvement; (4) lateral intracranial extension of the tumor over the orbital roof; (5) superolateral intraorbital extension; (6) encasement of major vessels; and (7) involvement of the facial soft tissues. These cases could be better treated with a combination of endoscopic and external approaches …”

“…Others smaller series have been described previously in the literature (Table 4). 4,6,13,[21][22][23][24][25][26][27][28][29] We have treated a total of 11 patients with sinonasal schwannomas and, to the best of our knowledge, this is the largest series from a single institution focusing on the role of the endoscopic approach for the treatment of these tumors.…”