Farzad A Masroor1, Jason Gilde2, Jonathan Liang3. 1. Resident Physician in the Department of Otolaryngology-Head and Neck Surgery at the Oakland Medical Center in CA (farzad.a.masroor@kp.org). 2. Fellow Physician in the Department of Otolaryngology-Head and Neck Surgery at the Loma Linda University Medical Center in CA (jason.gilde@gmail.com). 3. Surgeon in the Department of Otolaryngology-Head and Neck Surgery at the Oakland Medical Center in CA (jonathan.liang@kp.org).
Abstract
INTRODUCTION: Vidian nerve schwannomas are exceedingly rare, with only 7 cases reported since 2006. Patients presenting with ocular symptoms have been reported in only 1 case. CASE PRESENTATION: A 54-year-old woman presented with a 3-month history of right periorbital pressure, third cranial nerve palsy, and visual field defect. Imaging results showed a right sphenoid skull-base mass with obliteration of the vidian canal that extended into the pterygopalatine fossa. The patient underwent an extended endoscopic resection with pterygopalatine fossa dissection. Pathologic findings demonstrated a schwannoma. DISCUSSION: A literature review showed that this is the second reported case of a vidian nerve schwannoma presenting with ocular symptoms and that endoscopic resections are becoming the standard of care. Practitioners should be aware that vidian nerve schwannomas can present as a skull-base mass with predominantly ocular symptoms, including vision loss, secondary to mass effect. Consideration should be given to this entity in the setting of typical radiographic and histopathologic characteristics. Endoscopic approaches to resection are safe and have low morbidity.
INTRODUCTION: Vidian nerve schwannomas are exceedingly rare, with only 7 cases reported since 2006. Patients presenting with ocular symptoms have been reported in only 1 case. CASE PRESENTATION: A 54-year-old woman presented with a 3-month history of right periorbital pressure, third cranial nerve palsy, and visual field defect. Imaging results showed a right sphenoid skull-base mass with obliteration of the vidian canal that extended into the pterygopalatine fossa. The patient underwent an extended endoscopic resection with pterygopalatine fossa dissection. Pathologic findings demonstrated a schwannoma. DISCUSSION: A literature review showed that this is the second reported case of a vidian nerve schwannoma presenting with ocular symptoms and that endoscopic resections are becoming the standard of care. Practitioners should be aware that vidian nerve schwannomas can present as a skull-base mass with predominantly ocular symptoms, including vision loss, secondary to mass effect. Consideration should be given to this entity in the setting of typical radiographic and histopathologic characteristics. Endoscopic approaches to resection are safe and have low morbidity.