Intraorbital Oculomotor Nerve Schwannoma Affecting Only the Parasympathetic Fibers^[*]

Introduction

Typically, oculomotor nerve schwannomas present with various degrees of oculomotor nerve palsy, ptosis, diplopia, pain in the distribution of the first branch of the trigeminal nerve[3] [4] [9] [12] [13] [15] [16] [18] and may be associated with neurofibromatosis type 2. In the literature, we found 3 case reports of an oculomotor nerve schwannoma mimicking ophthalmoplegic migraine in younger patients,[1] [8] [15] and 3 other case reports of an asymptomtic schwannoma of the oculomotor nerve.[2] [7] [10]

Schwannomas originating from the oculomotor nerve are extremely rare. Approximately 45 cases of oculomotor nerve schwannomas have been reported in the literature so far.[9] [16] In a recent review, only 4 out of 38 oculomotor nerve schwannomas were located in the orbit.[16] To the best of our knowledge, this is the first case of an intraorbital oculomotor nerve schwannoma presenting exclusively with an isolated, fixed and dilated pupil, dysfunction of accommodation, exophthalmos, and deterioration of vision. Diplopia, headaches (or ophthalmoplegic migraine), and paresis of the extrinsic ocular muscles were missing.

^* This article was originally published online in Central European Neurosurgery on September 29, 2011 (DOI:10.1055/s-0031-1279755)

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