Subfrontal schwannoma: a case report and literature review

doi:10.1016/j.jocn.2003.10.026

Journal of Clinical Neuroscience

Volume 11, Issue 6, August 2004, Pages 663-665

https://doi.org/10.1016/j.jocn.2003.10.026 Get rights and content

Abstract

Subfrontal schwannomas are rare and usually misdiagnosed preoperatively. We present the third reported case of a schwannoma arising from the olfactory nerve. The neuroradiological and pathological features of the case, as well as the origin of the tumour are discussed.

Introduction

Subfrontal schwannomas are rare tumours. Only 24 cases have been previously reported with only two cases from the olfactory nerve. We report the third case of a schwannoma arising from the olfactory nerve.

Section snippets

Case report

A 33-year-old female was referred to our centre following a generalised tonic-clonic seizure. She was previously well with no known family history of neurofibromatosis. Examination revealed no neurological deficit. Computerised tomography (CT) scan showed a subfrontal mass which was interpreted as a meningioma. Magnetic resonance imaging (MRI) revealed a 3 × 2.5 × 2 cm ovoid subfrontal extra-axial mass arising above the right cribriform plate. Its base on the cribiform plate was relatively small

Discussion

Subfrontal schwannomas are rare tumours with only 24 reported cases in the literature.[8], [9], [10], [12], [13], [14], [15], [16], [17], [19], [20], [21], [22], [23], [25], [33], [34] Of these, only three cases (including our case) were found to be attached to the olfactory nerve.[11], [24]

The origin of subfrontal schwannomas is unknown. Schwannomas commonly arise from peripheral or cranial nerves. Those on cranial nerves arise distal to the junctional zone adjacent to the brainstem where the

Conclusion

We present the case of a young woman with a subfrontal schwannoma, who presented with a generalized tonic clonic seizure. Radiological diagnosis was meningioma, but at operation, the tumour was found to be arising from the olfactory nerve and histology showed typical features of schwannoma. Although the origin of subfrontal schwannomas is not known, the intimate association of the tumour in our case with the olfactory nerve suggests that it arose in that structure.

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Cited by (26)

Subfrontal Schwannoma: Case Report and Review of Literature
2018, World Neurosurgery
Citation Excerpt :
Perhaps the most common presentation in young adults suggests alterations in the development or probable hamartomatous origin.5,10 The nondevelopment theories claim that olfactory groove schwannomas arise from Schwann cells located in adjacent structures to the region, such as the perivascular nerve plexus, meningeal branches of the trigeminal nerve, anterior ethmoidal nerve, or dural nerves of the anterior skull base and subarachnoid space.1-3,10,12,14,16,19-22 Fuller et al described in the adult human brain an additional cranial nerve named terminalis nerve or cranial nerve zero, conformed by a microscopic nervous plexus, not myelinated, and located bilaterally in the rectus gyrus.
Although attributing the origin of schwannomas from the olfactory nerve is nearly impossible, if they do not have Schwann cells, intracranial supratentorial schwannomas are mainly located in the anterior skull base.
We present the case of a 46-year-old female who presented with right tinnitus, dizziness, and bifrontal headache, progressive, starting 2 years before. Imaging studies revealed an incidentally neoplastic, extraaxial, homogeneously appearing tumor on the right anterior skull base. The patient underwent surgical treatment with total resection of the tumor by a bicoronal approach. The histopathologic study reported schwannoma.
We describe this case in detail and discuss the likely origin of this tumor, with a concomitant literature review.
Anterior skull-base schwannoma
2017, Neurocirugia
Los schwannomas son neoplasias de la vaina nerviosa originadas de las células de Schwann. Usualmente son solitarios y esporádicos, presentándose en relación a nervios periféricos, espinales o craneales. A nivel intracraneal, presentan una gran predisposición a originarse en el viii par craneal, especialmente en pacientes con neurofibromatosis tipo 2. Los schwannomas de la base anterior del cráneo corresponden a menos del 1% del total de schwannomas intracraneanos. Son frecuentes en pacientes jóvenes y usualmente tienen un curso clínico benigno. Estos tumores representan un reto diagnóstico debido a su poca incidencia y sus diagnósticos diferenciales. Se han planteado varias teorías sobre su origen y desarrollo. Se presenta el caso de un paciente varón de 13 años sin estigmas clínicos de neurofibromatosis, con un cuadro de cefalea, dolor ocular, papiledema y disminución de la agudeza visual en el cual se documentó un tumor único ubicado en la fosa craneal anterior. Se realizó una resección completa de la masa tumoral, cuyo diagnóstico histopatológico fue de schwannoma, y presentó una recuperación clínica de todos sus síntomas. En una revisión bibliográfica se ubicó un total de 66 pacientes reportados a nivel mundial con este diagnóstico. Se describen sus características epidemiológicas y clínicas más relevantes, así como la relación con los tumores de las células de la vaina olfatoria, una entidad descrita recientemente y que presenta gran similitud.
Schwannomas are nerve sheath tumours that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. Intracranial schwannomas tend to manifest on the eighth cranial nerve, particularly in patients with neurofibromatosis type 2. Anterior skull-base schwannomas represent less than 1% of all intracranial schwannomas. They are more frequent in young people and are typically benign. These tumours represent a diagnostic challenge due to their rarity and difficult differential diagnosis, and numerous theories have been postulated concerning their origin and development. In this article, we present the case of a 13-year-old male with a single anterior cranial-base tumour not associated with neurofibromatosis who presented with headache, papilloedema, eye pain and loss of visual acuity. Complete resection of the tumour was performed, which was histopathologically diagnosed as a schwannoma. The patient made a complete clinical recovery with abatement of all symptoms. We conducted a review of the literature and found 66 cases worldwide with this diagnosis. We describe the most relevant epidemiological and clinical characteristics of this kind of tumour and its relation with the recently discovered and similar olfactory schwannoma.
Unilateral Endoscopic Endonasal Surgery for Resection of an Olfactory Schwannoma of the Anterior Cranial Base in a Patient with Hereditary Hemorrhagic Telangiectasia
2016, World Neurosurgery
Olfactory schwannomas of the anterior cranial base (ACB) are rare tumors, and their association with hereditary hemorrhagic telangiectasia (HHT) has not previously been described. The majority of ACB schwannomas arise from the sinonasal tracts and may demonstrate intracranial extension. We report a case of an olfactory schwannoma-dense adherence to the basal frontal lobe. Complete tumor resection was performed through a unilateral extended endonasal endoscopic approach with preservation of the contralateral olfactory bulb. Anterior cranial base repair was achieved with the use of a mucoperichondrial vascularized pedicled nasoseptal flap.
A 25-year-old woman with a history of migraines presented with unilateral epistaxis and progressive worsening of her headache symptoms. The patient had a history of HHT. Nasal endoscopy showed mild telangiectasias, but no clear evidence of a mass. A computerized tomographic scan showed a large left-sided expansile lesion in the left ethmoid region with expansion and remodeling of the anterior cranial base and medial left orbit. Magnetic resonance imaging with contrast showed the mass to be avidly enhancing. Angiography was performed and demonstrated a mild vascular blush.
We report a rare case of HTT and olfactory schwannoma completely resected with a unilateral extended endoscopic endonasal approach. Reconstruction was performed with the use of nasoseptal flap. This is the first reported single-stage fully endoscopic endonasal unilateral approach for resection of an olfactory schwannoma with preservation of the contralateral olfactory cleft. The patient's sense of smell and taste was maintained after surgery.
Anterior fossa schwannoma mimicking an olfactory groove meningioma: Case report and literature review
2013, Neurochirurgie
Intracranial schwannomas not associated with cranial nerves account for less than 1% of surgically treated schwannomas of the central and peripheral nervous system. With only 45 cases reported to date, subfrontal schwannomas are very rare tumors, leaving the issue of their origin controversial. A 66-year-old woman presented with a 1-year history of progressive headaches. Clinical examination revealed hypoesthesia of the nasal tip. CT-scan and MRI studies revealed a large subfrontal tumor thought preoperatively to be a meningioma. Intraoperatively, a large extra-axial tumor arising from the floor of the right frontal fossa was encountered. Histopathology identified the tumor as a schwannoma. This current case gives strong clinical presumption of an origin from the anterior ethmoidal nerve. We reviewed the literature in order to establish the epidemiology of these tumors, from which there appear to be divergent profiles depending on tumor origin and histology. Despite close similarities with olfactory groove meningiomas, patient history and radiological findings provide substantial evidence for differential diagnosis.
Les schwannomes intracrâniens non associés aux paires crâniennes représentent moins de 1 % des schwannomes opérés. Avec seulement 45 cas reportés, les schwannomes de la fosse antérieure constituent un groupe rare de tumeur, dont l’origine prête à controverse. Nous reportons le cas d’une patiente de 66 ans aux antécédents de céphalées depuis un an. L’examen clinique ne retrouvait qu’une hypoesthésie unilatérale de la pointe du nez. L’imagerie TDM et IRM ont permis d’identifier une volumineuse tumeur sous-frontale envahissant l’ethmoïde, évoquant un méningiome olfactif. L’analyse anatomopathologique de la pièce opératoire concluait cependant en un schwannome bénin. Ce cas évoque fortement une tumeur originaire du nerf ethmoïdal antérieur. Nous avons réalisé une revue de la littérature dans l’objectif d’établir une épidémiologie de ces tumeurs, qui semblent présenter des profils divergents. En dépit d’une grande similarité avec les méningiomes de la gouttière olfactive, l’histoire clinique et l’imagerie préopératoire offrent de nombreux éléments de différentiation.
Imaging of the Anterior Skull Base
2009, Neuroimaging Clinics of North America
Citation Excerpt :
They tend to show high signal on T2-weighted imaging and show intense contrast enhancement (Fig. 17B). Because of their particular location and imaging features, they are often misdiagnosed for olfactory groove meningioma or olfactory neuroblastomas.28 A mucocele is a common benign expansile lesion that develops in the sinonasal area.
A new case of "olfactory schwannoma"; presentation and literature review
2009, Neurocirugia
Presentamos el caso de un paciente varón de 54 años que acude a Urgencias por cefalea importante de 6 días de evolución así como por una disfasia nominal ocasional. No presentaba anosmia ni otra sintomatología. El TAC urgente y la RM craneal posterior muestran una gran tumoración extra-axial frontobasal de 7×6×5 cm de diámetro, localizada mas sobre el lado derecho de la lámina cribosa, que capta contraste hetereogéneamente y cuyo diagnóstico de sospecha fue meningioma del surco del olfatorio. Tras su exéresis total mediante craneotomía bifrontal, la anatomía patológica es informada como schwanoma de tipo convencional. Dada la rareza de este tipo de tumores (26 hasta la fecha), revisamos la literatura, sus posibles diferencias radiológicas con el meningioma del surco del olfatorio y las diversas teorías acerca de su origen.
We report the case of a 54-year-old man who presented at the Emergency Department with intense headache of 6-days duration and sporadic nominal dysphasia. He did not present anosmia and the rest of the examination was normal. The emergency CT and the posterior cerebral MR showed a great subfrontal extra-axial mass of 7×6×5 cm, over the right side of the cribiform plate, hetereogeneously enhancing after gadolinium administration. Preoperative diagnosis was olfactory groove menigioma. After total removal by bifrontal craniotomy the histopathological diagnosis was schwannoma of the conventional type. Owing to the unusual frequency of this kind of tumors (26 to the date), we review the literature, the possible radiological differences with olfactory groove meningiomas and the different theories about their origin.

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Case reportSubfrontal schwannoma: a case report and literature review

Abstract

Introduction

Section snippets

Case report

Discussion

Conclusion

Surg. Neurol.

Clin. Neurol. Neurosurg.

Clin. Neurol. Neurosurg.

Neurochirugia

Am. J. Otolaryngol.

Subfrontal schwannoma – case report

Neurol. Med. Chir.

A case report of subfrontal schwannoma

No Shinkei Geka

Solitary neurinoma of the anterior cranial fossa: case report

J. Neurosurg. Sci.