Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. Trigeminal schwannomas are rare intracranial tumors. Here, we report a 35-year-old female presenting with an axial proptosis of right eyeball with right-sided III, IV and VI cranial nerve palsy. Her best corrected visual acuity in the right eye was perception of light absent and in the left eye was 20/20. MRI scan revealed a large right-sided heterogeneous, extra-axial middle cranial fossa mass that extended to the intraconal space of right orbit. A diagnosis of intracranial trigeminal nerve schwannoma with right orbital extension was made. Successful surgical excision of the mass with preservation of the surrounding tissues and orbital exenteration was done. Post-operative period was uneventful.INTRODUCTION: We present a rare case of schwnnoma of the right trigeminal nerve (V1 segment) of 40 year female patient presented with pain and watering in the right eye redness and forward proptosis. CT brain reveals intraconal mixed density lesion with solid cystic component causing proptosis and widening of optic canal extending to middle cranial fossa possibly optic nerve glioma. MRI of brain reveals intensely heterogeneously enhancing orbital neoplasm with intra and extra conal component with areas of haemorrhage and necrosis. The lesion seen to encase right cavernous sinus and right internal carotid artery and displacing the cavernous sinus medially and pituitary laterally possibly optic nerve sheath tumour -schwannoma or optic nerve glioma. However HPR reveals schwannoma of the V1segment of right trigeminal nerve.Schwannomas are usually benign (WHO GRADE I) tumors arising from the schwann cells in the axon myelin sheaths. [1] Trigeminal schwannomas are rare intracranial tumors, accounting for 0.8% to 8% of intracranial schwannomas. Trigeminal schwannomas are much less common than acoustic neuroma. [2] This benign tumor grow larger and spread into extracranial compartments through the foramina in the skull. [3] The variable location and presentation of this tumor makes the diagnosis difficult. The diagnosis is usually confirmed by histopathological examination. Here we present a rare case of benign intracranial trigeminal schwannoma arising from right parasellar region extending to intraconal space of the right orbit which was managed successfully by surgery.
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