Trimble Duncan J, Dawes Bryden H, Zeineddine Hussein A, Guttenberg Katie B, Yao William C, Bhattacharjee Meenakshi, Blackburn Spiros L
1Departments of Neurosurgery.
2Endocrinology.
J Neurosurg Case Lessons. 2023 Apr 17;5(16). doi: 10.3171/CASE2375.
Intracranial carotid sympathetic plexus (CSP) nerve sheath tumors have rarely been reported in the literature. This study describes the first reported case of a CSP neurofibroma and the first case of a CSP nerve sheath tumor treated via an endoscopic endonasal approach followed by adjuvant radiosurgery.
A 53-year-old man presented with 3 days of headaches and diplopia and was found to have a complete left abducens nerve palsy. Computed tomography (CT) revealed a smoothly dilated left carotid canal, CT angiography revealed a superiorly displaced left internal carotid artery (ICA), and magnetic resonance imaging revealed a T2-hyperintense and avidly enhancing lesion in the left cavernous sinus encasing the ICA. The patient underwent subtotal resection via an endoscopic transsphenoidal transcavernous approach followed by Gamma Knife radiosurgery.
Nerve sheath tumors arising from the CSP are extremely rare but need to be considered when assessing unusual cavernous sinus lesions. The clinical presentation is dependent on the anatomical location of the tumor and its relationship to the ICA. The optimal treatment paradigm is unknown.
颅内颈动脉交感神经丛（CSP）神经鞘瘤在文献中鲜有报道。本研究描述了首例报道的CSP神经纤维瘤病例以及首例经鼻内镜入路治疗并辅助立体定向放射外科治疗的CSP神经鞘瘤病例。
一名53岁男性因头痛和复视3天就诊，发现左侧展神经完全麻痹。计算机断层扫描（CT）显示左侧颈动脉管平滑扩张，CT血管造影显示左侧颈内动脉（ICA）向上移位，磁共振成像显示左侧海绵窦内有一个T2高信号且强化明显的病变，包绕ICA。该患者经鼻内镜经蝶窦经海绵窦入路行次全切除，随后接受伽玛刀立体定向放射外科治疗。
起源于CSP的神经鞘瘤极为罕见，但在评估不寻常的海绵窦病变时需要考虑。临床表现取决于肿瘤的解剖位置及其与ICA的关系。最佳治疗模式尚不清楚。
