Murofushi Keisuke, Tsutsumi Satoshi, Tomita Shigeki, Yamataka Motoki, Sugiyama Natsuki, Ueno Hideaki, Ishii Hisato
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan.
Department of Pathology, Juntendo University Urayasu Hospital, Urayasu, Japan.
Surg Neurol Int. 2024 Nov 1;15:400. doi: 10.25259/SNI_782_2024. eCollection 2024.
Orbital schwannomas arising from the frontal nerve are a rare but distinct entity.
A 16-year-old girl presented to our hospital with gradually progressive proptosis. Computed tomography (CT) performed 2 years ago incidentally detected a retrobulbar mass in the left orbit measuring 13 mm × 14 mm × 10 mm, which was not identified on CT performed at the age of 4 years. CT taken at presentation revealed marked tumor growth over 2 years, measuring 24 mm × 20 mm × 17 mm. On magnetic resonance imaging (MRI), the tumor appeared homogeneously isointense both on the T1- and T2-weighted sequences. The patient underwent transcranial tumor resection. Following unilateral frontal craniotomy, an osteotomy was made to the left anterior fossa floor. On reflecting, the periorbita revealed the frontal nerve with the proximal segment intermingled with the tumor. The levator and superior rectus muscles were flattened and located immediately beneath the tumor. A gross total resection was performed. Microscopic findings of the resected tumor were consistent with schwannoma.
Frontal nerve schwannomas may grow rapidly under certain conditions. Periodic follow-up using MRI and timely resection is recommended when an asymptomatic orbital tumor, possibly a frontal nerve schwannoma, is detected in young patients.
起源于额神经的眼眶神经鞘瘤是一种罕见但独特的实体。
一名16岁女孩因渐进性眼球突出前来我院就诊。两年前进行的计算机断层扫描（CT）偶然发现左眼眶球后有一个大小为13 mm×14 mm×10 mm的肿块，4岁时的CT检查未发现该肿块。就诊时的CT显示肿瘤在两年内显著生长，大小为24 mm×20 mm×17 mm。在磁共振成像（MRI）上，肿瘤在T1加权和T2加权序列上均呈均匀等信号。患者接受了经颅肿瘤切除术。在单侧额部开颅后，对左前颅窝底进行了截骨。翻开眶骨膜后，可见额神经，其近端与肿瘤混合。提上睑肌和上直肌变平，位于肿瘤下方。进行了肿瘤全切。切除肿瘤的显微镜检查结果与神经鞘瘤一致。
额神经鞘瘤在某些情况下可能迅速生长。当在年轻患者中检测到无症状眼眶肿瘤（可能是额神经鞘瘤）时，建议使用MRI进行定期随访并及时切除。
