Strategic Management of Anterior Skull Base Schwannomas and Their Outcomes

Abstract

Objective Endoscopic endonasal approach has revolutionized the surgery of benign nose and paranasal sinus tumors. In this study we describe our experience with this approach for schwannomas of anterior skull base which are extremely rare, vascular tumors of this region. We also discuss the strategic management and their outcomes to enlighten the existing literature.

Design Ambispective study.

Setting and Participants A total of eight cases of anterior skull base schwannoma were included. These cases were operated between 2018 and 2023 at a tertiary institute. Institutional ethical committee approval was obtained.

Main Outcomes Measured Medical records were obtained, and perioperative details (intraoperative findings, imaging findings, complications) were noted. Postoperative follow-up was done to note the outcomes of the patient.

Results There were five male and three female patients. All patients were between 20 and 40 years of age. All patients underwent contrast CT as well as MRI preoperatively. Most common symptoms in our series were nasal obstruction and intermittent epistaxis. The various sites involved were ethmoid labyrinth, maxillary sinus, septum, and olfactory fossa. All the cases were operated endoscopically.

Conclusion Endoscopic approach can be utilized in almost all cases of benign anterior skull base tumors with superior postoperative outcomes. Although there is a steep learning curve, use of subtle modifications of this technique help achieve better results. At the same time, it is imperative to understand that the surgeon should also be well versed with open approaches to help navigate difficult cases.

Keywords

sinonasal schwannomas - endoscopic - trigeminal - anterior skull base

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institution's ethics committee.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

The participants have consented to the submission of the case details for publication.

Availability of Data and Material

Data transparency has been maintained.

Authors' Contributions

All authors made substantial contribution to this paper and all the authors have approved the version to be published.

Publication History

Received: 08 June 2024

Accepted: 24 November 2024

Accepted Manuscript online:
02 December 2024

Article published online:
08 January 2025

• References

• 1 Hillstrom RP, Zarbo RJ, Jacobs JR. Nerve sheath tumors of the paranasal sinuses: electron microscopy and histopathologic diagnosis. Otolaryngol Head Neck Surg 1990; 102 (03) 257-263
• 2 Zhou H, Xing G, Gao X. et al. Schwannoma of the sinonasal tract and the pterygopalatine fossa with or without intracranial extension. ORL J Otorhinolaryngol Relat Spec 2015; 77 (02) 61-69
• 3 Suh JD, Ramakrishnan VR, Zhang PJ. et al. Diagnosis and endoscopic management of sinonasal schwannomas. ORL J Otorhinolaryngol Relat Spec 2011; 73 (06) 308-312
• 4 Kim YS, Kim HJ, Kim CH, Kim J. CT and MR imaging findings of sinonasal schwannoma: a review of 12 cases. AJNR Am J Neuroradiol 2013; 34 (03) 628-633
• 5 Sunaryo PL, Svider PF, Husain Q, Choudhry OJ, Eloy JA, Liu JK. Schwannomas of the sinonasal tract and anterior skull base: a systematic review of 94 cases. Am J Rhinol Allergy 2014; 28 (01) 39-49
• 6 Forer B, Lin LJ, Sethi DS, Landsberg R. Endoscopic resection of sinonasal tract schwannoma: presentation, treatment, and outcome in 10 cases. Ann Otol Rhinol Laryngol 2015; 124 (08) 603-608
• 7 Mertz JS, Pearson BW, Kern EB. Lateral rhinotomy. Indications, technique, and review of 226 patients. Arch Otolaryngol 1983; 109 (04) 235-239 [Internet]
• 8 Salamone FN, Seiden AM. Modern techniques in osteoplastic flap surgery of the frontal sinus. Oper Tech Otolaryngol Neck Surg [Internet] 2004; 15 (01) 61-66
• 9 Kitagawa Y, Baur D, King S, Helman JI. The role of midfacial degloving approach for maxillary cysts and tumors. J Oral Maxillofac Surg 2003; 61 (12) 1418-1422
• 10 Kang M, Jee Y-J, Lee DW. et al. Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report. Maxillofac Plast Reconstr Surg 2018; 40 (01) 38
• 11 Pasquini E, Sciarretta V, Frank G. et al. Endoscopic treatment of benign tumors of the nose and paranasal sinuses. Otolaryngol Head Neck Surg 2004; 131 (03) 180-186
• 12 Berlucchi M, Piazza C, Blanzuoli L, Battaglia G, Nicolai P. Schwannoma of the nasal septum: a case report with review of the literature. Eur Arch Otorhinolaryngol 2000; 257 (07) 402-405
• 13 Lee JT, Yoo F, Wang M, Vengerovich G, Suh JD. Modified endoscopic Denker approach in management of inverted papilloma of the anterior maxillary sinus. Int Forum Allergy Rhinol 2020; 10 (04) 533-538
• 14 Liu JK, Decker D, Schaefer SD. et al. Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Neurosurgery 2003; 53 (05) 1126-1135 , discussion 1135–1137