Schwannomas of the Nose and Paranasal Sinuses

Abstract

ABSTRACfSchwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusuallocation for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician wi(f be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immunochemistry in the diagnosis and treatment of these tumors will be discussed. (Am J Rhinology 7: [59][60][61][62][63][64][65] 1993) S Chwannomas are benign neoplasms of peripheral nerve sheath origin. Although several other terms have been applied to these lesions, schwannoma seems to be the most appropriate name because the cell of origin is the Schwann cell. 1 The sinonasal tract is an unusual location for these An Official Abstract form is included in the this issue of The American Journal of Rhinolol!.Y Am J Rhinology 65

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

“…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.…”

“…However, sinonasal schwannomas may be an incidental finding during imaging for other causes. In these cases, and especially in elderly patients, a “wait‐and‐scan” policy may be adopted, depending on the site, extent, and behavior of the disease …”

“…A preoperative biopsy could be taken into account when the radiological assessment excludes the vascular nature of the lesion (such as JNA in young men) and its site is accessible through a minimally invasive approach. The rationale for doing so is to rule out the possibility of malignant lesions, which might have similar radiological features, although requiring different and more aggressive treatment . Generally, schwannomas are relatively hypovascularized tumors, however, several articles have addressed cases of hypervascularized schwannomas of the sinonasal tract .…”

“…Frontal sinus schwannomas are uncommon with only 7 cases reported in literature . The management of frontal sinus disease still remains a challenging issue for rhinologists.…”

“…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.…”