Large trigeminal schwannoma of the infratemporal fossa: Evaluation of neoangiogenesis in this rare neoplasm

Alafaci, Concetta; Caffo, Maria; Barresi, Valeria; Cutugno, Mariano; Pino, Maria Angela; Granata, Francesca; Ponte, Francesco Saverio De; Salpietro, Francesco M.; Tomasello, Francesco

doi:10.1002/hed.23142

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…DSA was then performed to fully assess the abnormal blood supply, reduce intra-operative bleeding, and keep the surgical field clear. [ 15 ] Therefore, for neurogenic tumors with thickened blood vessels on CT images before surgery, although the tumor may be solid, DSA is required for precise diagnosis and design of the operational plan.…”

Section: Discussionmentioning

confidence: 99%

“…Although an abnormal arterial blood supply in solid tumors has rarely been reported in the literature, we suggest that DSA should be performed to determine whether there are abnormalities in well-known blood vessels. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…While waiting for pathological results, digital subtraction angiography (DSA) was conducted. [ 15 ] After inserting the contrast agent through femoral artery puncture, it was found that the branches of the maxillary artery, occipital artery, and posterior auricular artery were all involved in blood supply to the tumor area. At the same time, a deformed vascular nest, mainly supplied by the branches of the facial artery, could be seen in the submandibular area.…”

Section: Case Reportmentioning

confidence: 99%

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Pre-operative embolization and excision of vagal schwannoma with rich vascular supply

Xu¹,

Liu²,

Liu³

et al. 2022

Medicine

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Rationale: Schwannomas are benign tumors wrapped in the nerve sheath and can originate from the myelin sheath of the cranial nerve. In previous literature reports, most of the tumors were solid tumors, which can be removed only by surgery. This case report describes a unique case of vagal schwannoma, which, unlike previous cases, involves a dominant arterial supply, and discusses the pre-operative evaluation, relevant radiographic findings, and surgical process of the case in detail. Patient concerns: A 31-year-old woman sought treatment for pain in the left side of the neck when turning her head. A mass on the left side of the neck was found on enhanced computed tomography with a maximum diameter of 6.8 cm, along with multiple tortuous, thickened vascular shadows, and pressure on the left pharyngeal cavity. Diagnosis: The pathological results showed schwannoma. Interventions: Considering the unusual size of the tumor and thickened blood vessels revealed by pre-operative computed tomography, general anesthesia and biopsy were conducted first to confirm the diagnosis. Excessive bleeding occurred during the process; thus, the tumor was only partially removed before the wound closed after hemostasis. Digital subtraction angiography indicated that the tumor was supplied by multiple arteries, and the tumor was removed by pre-operative embolization plus intra-operative removal. Outcomes: Combined with embolization and surgical resection, the tumor was completely removed, the nerve was partially preserved, and the patient had postoperative hoarseness. Lesson: The present case indicates the possibility of vascularly supplied vagal schwannoma; thus, it is necessary to conduct pre-operative digital subtraction angiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

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Pre-operative embolization and excision of vagal schwannoma with rich vascular supply

Xu¹,

Liu²,

Liu³

et al. 2022

Medicine

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“…Besides vascular compression, other structural lesions such as tumors,[ 1 2 3 ] aneurysms or arteriovenous malformations,[ 11 14 ] arachnoidal cyst[ 8 ] may cause TN. In our case, the TN was related to a spontaneous hematoma into the MC.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Meckel′s cave hematoma: A rare cause of trigeminal neuralgia

et al. 2015

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Background:The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel's cave (MC) causing symptomatic TN is very rare.Case Description:We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive neurological improvement.Conclusion:Despite the number of lesions potentially affecting the MC, spontaneous hemorrhage is rare but should be taken into account in the differential diagnosis.

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“…For both adult and pediatric multicompartmental lesions, surgical corridors may include combinations of presigmoid, frontotemporal, subtemporal/ transpetrosal, and two-stage middle and posterior fossa exposures, [2][3][4][5][6]11 with or without the addition of endonasal endoscopic 2,[12][13][14][15][16] or transfacial (transmaxillary/transmandibular) approaches to target significant infratemporal extension. 4,11,[17][18][19] Management of TS in pediatric patients presents additional challenges because of anatomical differences, the potential for impact on development, and the need to minimize blood loss. Balancing treatment goals, including curative complete resection and minimizing morbidity, should occur in the context of the longer relative life expectancy of a child compared to that of an adult patient.…”

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confidence: 99%

Pediatric multicompartmental trigeminal schwannoma: illustrative case

Landry

Vaughan

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

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Large trigeminal schwannoma of the infratemporal fossa: Evaluation of neoangiogenesis in this rare neoplasm

Cited by 9 publications

References 21 publications

Pre-operative embolization and excision of vagal schwannoma with rich vascular supply

Pre-operative embolization and excision of vagal schwannoma with rich vascular supply

Spontaneous Meckel′s cave hematoma: A rare cause of trigeminal neuralgia

Pediatric multicompartmental trigeminal schwannoma: illustrative case

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