Brahmbhatt Pavan, Kumar Tushar, Bhatt Alok A, Vibhute Prasanna, Patel Vishal, Desai Amit, Gupta Vivek, Agarwal Amit
Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
Ear Nose Throat J. 2023 Feb 12:1455613221150573. doi: 10.1177/01455613221150573.
Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations.
A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma.
We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%).
We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.
施万细胞瘤是常见的神经鞘瘤，可发生于身体的任何部位。4%的头颈部施万细胞瘤发生于鼻窦腔，而具有颅内成分的则更少，使得这些病例极为罕见。此外，施万细胞瘤的影像学表现不具特异性，只能通过组织病理学检查才能明确鉴别，这导致其常被误诊为各种鼻腔肿瘤。我们旨在对已发表的关于伴有或不伴有颅内扩展的鼻窦施万细胞瘤的文献进行综述，并提供更多病例展示。
使用PubMed数据库，以“鼻窦施万细胞瘤”“颅内”“前颅底”和“施万细胞瘤”为关键词进行文献综述。对结果进行审查，并将识别出的其他病例纳入研究并进行引用。纳入标准为施万细胞瘤伴有颅内扩展的任何病例。无排除标准。将综述数据整理到Excel中，用于数据分析和比较。此外，在我们机构内部进行搜索，以识别更多鼻窦施万细胞瘤病例。
我们识别出17例伴有颅内扩展的鼻窦施万细胞瘤病例，其中5例来自我们机构，12例来自文献。分析显示：女性8例（47%），男性9例（53%）；9例患者出现头痛（53%），6例患者出现嗅觉减退（35%），4例患者出现鼻塞（24%），2例患者无症状（12%）。平均年龄和中位数分别为39.4±10.1岁和40岁。治疗方面，4例患者接受了内镜切除术（24%），11例患者接受了开颅手术（65%），2例患者的数据未提供。6例患者出现治疗后并发症，5例发生脑脊液漏（29%），1例发生血肿（6%）。
我们识别并讨论了17例伴有颅内扩展的鼻窦施万细胞瘤病例。我们希望我们的综述能为临床医生在评估鼻腔和前颅底肿物时将施万细胞瘤作为一种潜在的鉴别诊断提供参考。
